Seronegative Type I Autoimmune Pancreatitis With Immunoglobulin G4-Related Disease Triggered by the Pfizer-Biontech Covid-19 Vaccine

Rodrigues, Terrance; Komanduri, Sri

doi:10.1016/j.gie.2022.04.130

Cited by 7 publications

(17 citation statements)

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“…An increasing number of new-onset cases of rheumatoid arthritis (8), systemic lupus erythematosus (9), dermatomyositis (10), autoimmune hepatitis (11), and thyroiditis (12) have also been described. To our knowledge, four cases of new-onset or relapsed IgG4-RD have been reported after COVID-19 mRNA vaccination (13)(14)(15)(16), with this representing the fifth reported case (Table 2).…”

Section: Discussionmentioning

confidence: 91%

IgG4-related Disease Emerging after COVID-19 mRNA Vaccination

2023

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A 78-year-old Japanese woman with no history of rheumatic disease received 2 doses of the BNT162b2 COVID-19 mRNA vaccine. Two weeks later, she noticed bilateral swelling in the submandibular region. Blood tests showed hyper-immunoglobulin (Ig)G4emia, and 18 F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) revealed the strong accumulation of FDG in the enlarged pancreas. She was diagnosed with IgG4-related disease (IgG4-RD) according to the American College of Rheumatology (ACR)/the European League Against Rheumatism (EULAR) classification criteria. Treatment was started with prednisolone at 30 mg/day, and the organ enlargement improved. We herein report a case of IgG4-RD that may have been associated with an mRNA vaccine.

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Section: Discussionmentioning

confidence: 91%

IgG4-related Disease Emerging after COVID-19 mRNA Vaccination

2023

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“…The difficulty in identifying a correct diagnosis is exacerbated by the low incidence rate of PSC 2 (0.5-1.3 cases per 100,000 person-years) and significantly rarer incidence of IgG4-seronegative AIC. 3,4 Ten years after initial presentation, a correct diagnosis was made for this patient, allowing initiation of therapy that normalized liver tests and improved biliary strictures. He has improved his quality of life substantially and has for now delayed proceeding to liver transplantation.…”

Section: Discussionmentioning

confidence: 94%

“…The difficulty in identifying a correct diagnosis is exacerbated by the low incidence rate of PSC 2 (0.5–1.3 cases per 100,000 person-years) and significantly rarer incidence of IgG4-seronegative AIC. 3,4…”

Section: Discussionmentioning

confidence: 99%

Immunoglobulin G4-Seronegative Autoimmune Cholangiopathy With Pancreatic and Hepatic Involvement Mimicking as Primary Sclerosing Cholangitis

et al. 2023

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Immunoglobulin G4-seronegative autoimmune cholangiopathy is a rare cause of biliary strictures. We describe a 27-year-old man presenting with elevated liver enzymes, recurrent cholangitis/bacteremia, biliary strictures, and normal immunoglobulin G4 levels, who was initially diagnosed with primary sclerosing cholangitis, and later listed for transplantation for recurrent bacteremia. Subsequent surveillance imaging demonstrated morphologic changes consistent with biliary strictures and autoimmune pancreatitis. Initiating corticosteroids resulted in liver enzyme normalization and stricture improvement. Diagnosing seronegative autoimmune cholangiopathy remains challenging given similar presentation to primary sclerosing cholangitis. This case highlights importance of a wide differential for biliary strictures, with increased suspicion in those developing pancreatic changes in this setting.

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“…Recent reports have indicated that COVID-19 vaccinations using mRNA or viral vector vaccines can trigger autoimmune diseases such as sialadenitis, autoimmune hepatitis (AIH), or autoimmune pancreatitis (AIP) in selected individuals [ 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ]. In the literature, several reports have treated the correlation between autoimmune pancreatitis and COVID-19 vaccination ( Table 3 ).…”

Section: Discussionmentioning

confidence: 99%

Significantly Elevated CA 19-9 after COVID-19 Vaccination and Literature Review of Non-Cancerous Cases with CA 19-9 > 1000 U/mL

Ciesielka,

Jakimów,

Tekiela

et al. 2024

JCM

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Background: CA 19-9 is a commonly assessed tumor marker, considered characteristic of pancreatic ductal adenocarcinoma (PDAC) and biliary tract cancers; however, the positive predictive value of CA 19.9 is too low, and the usage of CA 19.9 as a screening tool in the healthy population remains controversial. Methods: The presented case illustrates a reversed diagnosis of highly elevated serum CA 19-9 levels in a 54-year-old female complaining of pain in the epigastric region, shortly after COVID-19 vaccination. Laboratory tests showed a significantly elevated level of the CA 19-9 marker (>12,000 U/mL, reference value: <37 U/mL) with normal pancreatic enzyme activity. The patient underwent imaging examination, which showed no abnormalities, except for increased pancreatic dimension and areas of fluid signal in the pancreas in magnetic resonance imaging (MRI), which may correspond to autoimmune pancreatitis (AIP). The patient remains asymptomatic with a recommendation for a follow-up MRI in 12 months. Results: A literature review conducted revealed multi-causal CA 19-9 increases above 1000 U/mL, including non-cancerous diseases of the lung, pancreas, liver, ovary, kidney, and others. The median concentration of CA 19-9 regardless of the cause of disease was 2810 U/mL (IQR ± 6895). The median CA 19-9 values in men and women were 3500 (IQR ± 10,050) and 2455 (IQR ± 3927), respectively, and differ significantly between the compared groups (p < 0.05). There was no difference between CA 19-9 values and the categorized cause of the increase. Conclusions: Conducting differential diagnosis, it should not be forgotten that most international guidelines recommend the use of CA 19-9 only in conjunction with pathology of pancreas in radiological imaging; however, even such a combination can point the diagnostic pathway in the wrong direction. A highly elevated CA 19-9 level, typically associated with PDAC, may be the result of benign disease including AIP related to COVID-19 vaccination.

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Seronegative Type I Autoimmune Pancreatitis With Immunoglobulin G4-Related Disease Triggered by the Pfizer-Biontech Covid-19 Vaccine

Cited by 7 publications

References 0 publications

IgG4-related Disease Emerging after COVID-19 mRNA Vaccination

IgG4-related Disease Emerging after COVID-19 mRNA Vaccination

Immunoglobulin G4-Seronegative Autoimmune Cholangiopathy With Pancreatic and Hepatic Involvement Mimicking as Primary Sclerosing Cholangitis

Significantly Elevated CA 19-9 after COVID-19 Vaccination and Literature Review of Non-Cancerous Cases with CA 19-9 > 1000 U/mL

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