Reactivation of adult-onset Still’s disease after use of the COVID-19 ChAdOx1-S vaccine

Ibáñez, Sebastián; Murillo, Luis Morales; Vergara, Matías de la Rivera; Martínez, Roberto Saldías

doi:10.1136/bcr-2022-249290

Cited by 7 publications

(5 citation statements)

References 19 publications

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“…In rare case reports, new onset severe mitral regurgitation was also suggested to be related to AOSD ( 7 ). Although AOSD following mRNA vaccines is rare ( 8 – 10 ), it is critical for clinicians to be knowledgable about the condition as it is potentially life threatening, as in our patient who developed systemic inflammatory response and unstable hemodynamics from arrhythmia and heart failure. Prompt initiation of anti-inflammatory agents is mandatory to avert clinical deterioration and mortality.…”

Section: Discussionmentioning

confidence: 95%

RETRACTED: Case report: Coronavirus Disease 2019 (COVID-19) modified RNA vaccination-induced Adult-Onset Still's Disease with fulminant myocarditis as initial presentation

Zhou

Wong

Yeung

et al. 2023

Front. Cardiovasc. Med.

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Myocarditis is a rare complication of Coronavirus Disease 2019 (COVID-19) vaccination. We report a case of an elderly female who presented initially with acute myocarditis, fulminant heart failure, and atrial fibrillation after receiving a modified ribonucleic acid (mRNA) vaccine (BNT162b2). Unlike other patients with vaccine-induced myocarditis, she developed persistent fever, sore throat, polyarthralgia, diffuse macular rash, and lymphadenopathy. After extensive investigation, she was diagnosed with post-vaccination Adult-Onset Still's Disease. The systemic inflammation gradually subsided after the use of non-steroidal anti-inflammatory drugs and systemic steroids. She was discharged from hospital with stable hemodynamics. Methotrexate was subsequently given to maintain long-term remission.

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Section: Discussionmentioning

confidence: 95%

RETRACTED: Case report: Coronavirus Disease 2019 (COVID-19) modified RNA vaccination-induced Adult-Onset Still's Disease with fulminant myocarditis as initial presentation

Zhou

Wong

Yeung

et al. 2023

Front. Cardiovasc. Med.

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“…9-14 Flares of AOSD have also been reported, suggesting a possible correlation between the disease and SARS-CoV-2 vaccines. [15][16][17][18] The reported cases of a new occurrence of AOSD after SARS-CoV-2 vaccination, including the present case, are summarized in Table 1.…”

Section: Discussionmentioning

confidence: 92%

Occurrence of adult‐onset Still's disease after coronavirus disease 2019 BNT162B2 vaccination in a patient with ulcerative colitis: A case report and review of literature

Kobayashi,

Hashimoto,

Kusanagi

et al. 2023

Clinical Case Reports

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Key Clinical MessageWe report an extremely rare occurrence of adult‐onset Still's disease (AOSD) in a patient with ulcerative colitis. The possibility of autoinflammatory conditions such as AOSD should be considered when evaluating or treating symptoms suspected as side effects of the severe acute respiratory syndrome coronavirus 2 vaccination, regardless of the associated comorbidities.SummaryA woman in her 50s with a history of stable ulcerative colitis (UC) for 20 years, managed using salazosulfapyridine, presented with migratory rashes, spiking fever, edema, and joint pain that started 1 week after receiving the BNT162B2 mRNA vaccine against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Laboratory tests revealed extremely high serum ferritin levels. The patient was diagnosed with adult‐onset Still's disease (AOSD) based on the relevant classification criteria after ruling out other diseases. Detection of high levels of interleukin‐18, an inflammatory cytokine related to AOSD, supported the diagnosis. Nonsteroidal anti‐inflammatory drug monotherapy alone resulted in significant improvements in both the abovementioned symptoms and the elevated inflammatory marker levels. AOSD in a patient with UC is extremely rare. Only one case of AOSD with UC was reported before the coronavirus disease 2019 era. This case indicates that SARS‐CoV‐2 vaccination can trigger a hyperinflammatory response, classified as AOSD, in a patient with UC, which is extremely rare.

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“…SARS-CoV-2 infection could also induce cytokine storms driven by IL-6, IL-1α, IL-1β, and TNF-α [ 42 ], and the pathogenesis of both is similar. Multiple case reports have shown that vaccination against COVID-19 can induce a strong immune response [ 43 , 44 ]. However, it is not possible to distinguish whether an adverse effect of vaccination is the induction of new-onset AOSD or whether it is actually a relapse of existing AOSD that plays a major part in this mechanism.…”

Section: Discussionmentioning

confidence: 99%

New-Onset Arthritis Following COVID-19 Vaccination: A Systematic Review of Case Reports

Liu

Xia

2023

Vaccines

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Coronavirus disease 2019 (COVID-19) vaccine has effectively suppressed the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and alleviated its symptoms, but there are also many adverse events. Joint diseases caused by COVID-19 vaccine have been reported in many studies. Some are well-controlled arthritis patients who developed arthritis after COVID-19 vaccination, while others are new-onset joint pain and swelling problems after COVID-19 vaccination. The purpose of this systematic review is to examine the literature reports in existing databases and analyze the incidence of new-onset arthritis after COVID-19 vaccination. We included 31 eligible articles and described 45 patients, ranging in age from 17 to over 90, with more females than males. The majority (71.2%) of patients received the adenovirus vector vaccine (ChAdOx1) and the mRNA-based vaccine (BNT126b2 and mRNA-1273). Most (64.4%) patients developed joint-related symptoms after the first dose of vaccine, and 64.4% developed symptoms within the first week of vaccination. The joint symptoms involved were mainly joint swelling, joint pain, limited range of motion, and so on. A total of 71.1% of the patients involved multiple joints, both large and small; 28.9% of patients involved only a single joint. Some (33.3%) patients were confirmed by imaging, and the most common diagnoses were bursitis and synovitis. Two nonspecific inflammatory markers, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), were monitored in almost all cases, and all patients showed varying degrees of increase in these two markers. Most of the patients received the treatment of glucocorticoid drugs or nonsteroidal anti-inflammatory drugs (NSAIDs). Clinical symptoms markedly improved in most patients, with 26.7% making a full recovery and no relapse after a few months of follow-up. To determine whether there is a causal relationship between COVID-19 vaccination and the triggering of arthritis, large-scale and well-controlled research studies are needed in the future to verify this relationship and to further study its pathogenesis in detail. Clinicians should raise awareness of this complication with a view to early diagnosis and appropriate treatment.

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Reactivation of adult-onset Still’s disease after use of the COVID-19 ChAdOx1-S vaccine

Cited by 7 publications

References 19 publications

RETRACTED: Case report: Coronavirus Disease 2019 (COVID-19) modified RNA vaccination-induced Adult-Onset Still's Disease with fulminant myocarditis as initial presentation

RETRACTED: Case report: Coronavirus Disease 2019 (COVID-19) modified RNA vaccination-induced Adult-Onset Still's Disease with fulminant myocarditis as initial presentation

Occurrence of adult‐onset Still's disease after coronavirus disease 2019 BNT162B2 vaccination in a patient with ulcerative colitis: A case report and review of literature

New-Onset Arthritis Following COVID-19 Vaccination: A Systematic Review of Case Reports

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