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Ravilla J, He P, Patel AV. A Case Report of Post-COVID-19 Eosinophilic Enteritis: An Uncommon Diagnosis in an Adult. Cureus 2024; 16:e65265. [PMID: 39184805 PMCID: PMC11342823 DOI: 10.7759/cureus.65265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2024] [Indexed: 08/27/2024] Open
Abstract
Eosinophilic esophagitis (EoE) and eosinophilic gastroenteritis (EGE), also known as eosinophilic enteritis (EoN), are both parts of the eosinophilic gastrointestinal disease (EGID) and share pathogenic similarities. Over the past two decades, the incidence and prevalence of EoE have rapidly increased, especially in Western countries, while EGE remains rare. Unlike EoE, no standard treatment strategies or guidelines have been established due to the extreme rarity of EGE, especially in Western countries. Here, we report a rare case of EoN in a 35-year-old female resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
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Affiliation(s)
| | - Ping He
- Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Anish V Patel
- Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
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Yoshino Y, Tsuboi K. Eosinophilic Gastroenteritis Following Covid-19 MRNA Vaccination. Eur J Case Rep Intern Med 2024; 11:004316. [PMID: 38455695 PMCID: PMC10917407 DOI: 10.12890/2024_004316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 02/05/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Large-scale clinical studies for COVID-19 vaccines have shown the infection-preventing effect and short-term adverse effects. Some rare illnesses such as eosinophilia can develop following COVID-19 vaccinations. Case description We report a case of 65-year-old man with unexplained abdominal pain that developed 2 weeks after COVID-19 mRNA vaccination. The patient had received a second dose of COVID-19 mRNA vaccine and revealed eosinophilia at the first visit to our hospital. Eosinophil infiltration was observed in the lamina propria of the duodenum by a step biopsy. Montelukast 10 mg was administered as the initial treatment of eosinophilic gastroenteritis (EGE), and the abdominal pain was improved. Discussion The strong influence of COVID-19 vaccination on the development of EGE remains unproven. Reports of eosinophilia following COVID-19 vaccination have discussed that COVID-19 mRNA vaccination triggered an eosinophilic response. Conclusion This case presented EGE that developed following COVID-19 mRNA vaccination, which would be a rare adverse event. LEARNING POINTS Eosinophilia can develop following COVID-19 mRNA vaccination.To evaluate the relationships of these illnesses with vaccination, clinicians should collect information on vaccinations history and vaccination dates through interviews.It is clinically practical to know the differential diseases that may develop after a new vaccination.
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Affiliation(s)
- Yuta Yoshino
- Department of Internal Medicine, Saitama Citizens Medical Center, Saitama, Japan
| | - Ken Tsuboi
- Department of Internal Medicine, Saitama Citizens Medical Center, Saitama, Japan
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Misaki Y, Hayashi Y, Shirata M, Terada K, Yoshizawa A, Sakamoto R, Ikezoe K, Tanizawa K, Handa T, Hirai T. Resolution of Eosinophilic Pneumonia after Coronavirus Disease 2019 without Systemic Corticosteroids. Intern Med 2023; 62:3223-3230. [PMID: 37587039 PMCID: PMC10686740 DOI: 10.2169/internalmedicine.1648-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/02/2023] [Indexed: 08/18/2023] Open
Abstract
Pulmonary and extrapulmonary complications after coronavirus disease 2019 (COVID-19) have been major public health concerns during the COVID-19 pandemic. Although post-COVID-19 pulmonary manifestations cover a wide spectrum, eosinophilic pneumonia (EP) has rarely been reported. To date, only four cases of EP potentially triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported, all of which required systemic corticosteroid therapy. We herein report the first case of post-COVID-19 EP resolution without systemic corticosteroid therapy. We also review the literature regarding EP associated with SARS-CoV-2 infection and vaccination.
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Affiliation(s)
- Yumiko Misaki
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Japan
| | - Yusuke Hayashi
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Japan
| | - Masahiro Shirata
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Japan
- Department of Respiratory Medicine, Kyoto Preventive Medical Center, Japan
| | - Kazuhiro Terada
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Japan
| | - Akihiko Yoshizawa
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Japan
| | - Ryo Sakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Japan
| | - Kohei Ikezoe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Japan
| | - Kiminobu Tanizawa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Japan
| | - Tomohiro Handa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Japan
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Japan
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Koda T, Natsumoto B, Shoda H, Fujio K. Nonepisodic Angioedema with Eosinophilia Following Receipt of the BNT162b2 mRNA COVID-19 Vaccine. Intern Med 2023; 62:3063-3067. [PMID: 37468248 PMCID: PMC10641185 DOI: 10.2169/internalmedicine.1788-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/07/2023] [Indexed: 07/21/2023] Open
Abstract
Angioedema with eosinophilia (AE) is a rare disease of unknown etiology characterized by episodic (EAE) or nonepisodic AE (NEAE). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA-based vaccines function as immunogens and intrinsic adjuvants and have been shown to be safe in large-scale trials. However, the long-term adverse reactions, especially those related to eosinophilic complications, have not been fully clarified. We herein report a case of self-limited but severe NEAE that developed in a young woman one week after receiving the second BNT162b2 mRNA vaccine. The symptoms that impaired her activities of daily living, such as edema, gradually resolved with supportive care over 10 weeks without corticosteroid treatment.
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Affiliation(s)
- Tamaki Koda
- Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Bunki Natsumoto
- Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Hirofumi Shoda
- Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Keishi Fujio
- Department of Allergy and Rheumatology, Graduate School of Medicine, The University of Tokyo, Japan
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Nizam A, Gaballah S, Al Ozaibi L, Raman LG. Isotretinoin as a Possible Cause for Eosinophilic Esophagitis and Eosinophilic Gastroenteritis: A Case Report. Cureus 2023; 15:e42649. [PMID: 37644953 PMCID: PMC10461599 DOI: 10.7759/cureus.42649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 08/31/2023] Open
Abstract
A 39-year-old female patient who took isotretinoin for severe acne for around six months presented with severe upper abdominal pain, as well as abdominal distention. Initially, she was diagnosed with acute cholecystitis due to the presence of gallstones on ultrasound. However, additional imaging showed mural thickening of the bowel, for which she underwent further work-up. Laboratory investigations showed raised inflammatory markers along with eosinophilia. Concurrently, bedside paracentesis showed raised levels of eosinophils. The patient underwent an endoscopic assessment, which revealed eosinophilic esophagitis and gastroenteritis likely to be induced by isotretinoin. Following the discontinuation of isotretinoin and the initiation of corticosteroid therapy, the patient's clinical condition improved significantly. The diagnosis of eosinophilic gastrointestinal disorders, though rare, must be kept in mind when patients on long-term isotretinoin treatment or with other risk factors present with symptoms such as dysphagia, abdominal pain, odynophagia, nausea, and vomiting.
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Affiliation(s)
- Anjala Nizam
- Department of Medicine and Surgery, Dubai Academic Health Corporation, Dubai, ARE
| | - Sarah Gaballah
- Department of Medicine and Surgery, Dubai Academic Health Corporation, Dubai, ARE
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Fukuda Y, Hayashi H, Sagara H. COVID-19-Induced Eosinophilic Lower Airway Inflammation in Those With Multiple COVID-19 Vaccinations. Cureus 2023; 15:e38368. [PMID: 37265894 PMCID: PMC10230321 DOI: 10.7759/cureus.38368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2023] [Indexed: 06/03/2023] Open
Abstract
A 29-year-old woman was admitted with a diagnosis of ischemic enteritis. She had a coronavirus disease 2019 (COVID-19) infection four weeks before this visit and continued to experience a cough. Four months before, she received the third COVID-19 vaccine. Chest computer tomography revealed scattered ground-glass opacities in both upper lobes. Based on abnormalities in chest imaging, eosinophilia, and a high level of fractional exhaled nitric oxide, she was diagnosed with eosinophilic lower airway inflammation due to COVID-19. Since the visit, the patient had an intermittent fever and no radiological improvement, so systemic corticosteroid treatment was initiated, and the symptoms and clinical findings improved. Clinicians should know the potential association between COVID-19 and eosinophilic lower airway inflammation, which may still occur despite multiple vaccinations.
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Affiliation(s)
- Yosuke Fukuda
- Department of Medicine, Division of Respiratory Medicine and Allergology, Yamanashi Red Cross Hospital, Yamanashi, JPN
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, JPN
| | - Hidenori Hayashi
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University Koto Toyosu Hospital, Tokyo, JPN
| | - Hironori Sagara
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Tokyo, JPN
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Doman T, Saito H, Tanaka Y, Hirasawa D, Endo M, Togo D, Matsuda T. Colitis with Hypereosinophilia following the Second Dose of the BNT162b2 mRNA COVID-19 Vaccine: A Case Report with a Literature Review. Intern Med 2023; 62:865-869. [PMID: 36575012 PMCID: PMC10076129 DOI: 10.2169/internalmedicine.0518-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A 61-year-old man presented with a 7-day history of watery diarrhea and loss of appetite after receiving the second dose of the Pfizer-BioNTech COVID-19 vaccine. Laboratory studies showed significant eosinophilia and an elevated IgE level (white cell count, 18.4×109/L; eosinophil count, 9.5×109/L; and IgE level, 540 IU/L). Symptoms resolved 10 days after vaccination without any steroids or antiallergic medications, and the eosinophil count had also returned to within normal limits 2 months later. Several cases of eosinophilic disorders following receipt of any type of injectable COVID-19 vaccine have been reported, so the etiology should be examined.
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Affiliation(s)
- Tsuyoshi Doman
- Department of Gastroenterology, Sendai Kousei Hospital, Japan
- Graduate Medical Education Center, Tohoku University Hospital, Japan
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kousei Hospital, Japan
| | - Yukari Tanaka
- Department of Gastroenterology, Sendai Kousei Hospital, Japan
| | - Dai Hirasawa
- Department of Gastroenterology, Sendai Kousei Hospital, Japan
| | - Mareyuki Endo
- Department of Pathology, Sendai Kousei Hospital, Japan
| | - Daichi Togo
- Department of Gastroenterology, Sendai Kousei Hospital, Japan
| | - Tomoki Matsuda
- Department of Gastroenterology, Sendai Kousei Hospital, Japan
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Nam YH. Nonepisodic angioedema with eosinophilia after COVID-19 vaccination: a case successfully treated with reslizumab. Allergy Asthma Clin Immunol 2023; 19:11. [PMID: 36732834 PMCID: PMC9893190 DOI: 10.1186/s13223-023-00765-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/14/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Angioedema with eosinophilia (AE) is a rare allergic disease classified as episodic or nonepisodic. AE is characterized by angioedema, urticaria, fever, weight gain, and eosinophilia, but its etiology and pathogenesis have not yet been clarified. CASE PRESENTATIONS We present a 70-year-old woman presented with generalized edema and urticaria after Moderna COVID-19 vaccination. Peripheral blood eosinophil count was marked elevated and echocardiography and Doppler ultrasonography of both the upper and lower extremities were unremarkable. Her symptoms and peripheral blood eosinophil count were improved after systemic steroid therapy, but she failed to respond to steroid tapering. Reslizumab (anti-interluekin-5) was administered intravenously, and she remained symptom free with a normal eosinophil count during 8 months of reslizumab treatment without steroids. CONCLUSIONS We report a case of nonepisodic AE after COVID-19 vaccination that was successfully treated with reslizumab.
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Affiliation(s)
- Young-Hee Nam
- grid.255166.30000 0001 2218 7142Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
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