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Ciliberti V, Maffei E, Giudice V, Ciancia G, Zeppa P, Caputo A. COVID-19 vaccine-associated lymphadenopathy: a review. LE INFEZIONI IN MEDICINA 2024; 32:119-130. [PMID: 38827838 PMCID: PMC11142413 DOI: 10.53854/liim-3202-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/30/2024] [Indexed: 06/05/2024]
Abstract
Following the introduction of RNA-based vaccines, COVID-19 vaccine-associated clinical lymphadenopathy (C19-LAP) has been reported as a side effect. Moreover, subclinical lymphadenopathy detected on imaging (SLDI) has also been observed, mainly as incidental findings while performing screening tests on oncological patients. In these cases, surgical lymphadenectomy, fine-needle aspiration cytology (FNAC) and core needle biopsy (CNB) have been used as a valuable diagnostic tool for SLDI and C19-LAP. In this review the clinical, histologic and cytologic features of SLDI and C19-LAP have been investigated. A search for studies that reported on C19-LAP and SLDI histopathology and cytopathology was performed on PubMed and Google Scholar, on 11 January 2023. Thirty-one reports on SLDI and C19-LAP were retrieved and included in a pooled analysis. In total, we included 54 patients with a median age of 47 years. In our research, surgical excision, CNB and/or FNAC of C19-LAP or SLDI enlarged lymph nodes have been performed in 54 cases. Of all cases, only two metastases were diagnosed and one case was diagnosed as reactive hyperplasia with atypical follicles. The remaining cases were reactive lymphadenopathy (28 cases), follicular hyperplasia (13 cases), Kikuchi-Fujimoto disease (6 cases), granulomatous lymphadenitis (2 cases), eosinophilic lymph node abscesses (1 case), Langherans cell histiocytosis (1 case), Rosai-Dorfman disease (1 case). SLDI and C19-LAP have represented a diagnostic dilemma, especially in oncologic patients. The role of different diagnostic tools for SLDI and C19-LAP has been discussed.
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Affiliation(s)
- Valeria Ciliberti
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d’Aragona, University of Salerno,
Italy
| | - Elisabetta Maffei
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d’Aragona, University of Salerno,
Italy
| | - Valentina Giudice
- Hematology and Transplant Center, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d’Aragona, University of Salerno,
Italy
| | - Giuseppe Ciancia
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d’Aragona, University of Salerno,
Italy
| | - Pio Zeppa
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d’Aragona, University of Salerno,
Italy
| | - Alessandro Caputo
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d’Aragona, University of Salerno,
Italy
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2
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Mahdi S, Joudeh AI, Raman KS, Faqih SA, Alhatou MI, Wadiwala MF, Akhtar M, Lutf AQA. New-onset severe eosinophilic granulomatosis with polyangiitis following the third dose of mRNA COVID-19 vaccine: A case report. Mod Rheumatol Case Rep 2023; 8:153-158. [PMID: 37525576 DOI: 10.1093/mrcr/rxad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/17/2023] [Accepted: 07/13/2023] [Indexed: 08/02/2023]
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a complex multifactorial disease that results in multisystemic inflammation of the small- and medium-sized arteries. The exact pathogenesis of this syndrome is poorly understood, but it is postulated to result from a combination of eosinophilic dysfunction, genetic predisposition, and the development of autoantibodies after exposure to an unknown stimulus. We describe a case of new-onset EGPA following the third dose of the Pfizer-BioNTech mRNA vaccine in an infection-naive middle-aged man with a background history of allergic respiratory symptoms. The patient developed acute onset of mononeuritis multiplex, pauci-immune glomerulonephritis, and leucocytoclastic vasculitis 10 days after receiving the booster dose. His laboratory markers including eosinophil count, antineutrophil cytoplasmic antibodies, and renal function tests improved markedly after the initiation of pulse steroid therapy and rituximab infusion. However, his peripheral muscle weakness and neuropathic pain did not respond to the initial therapy but improved later with intravenous cyclophosphamide and intravenous immunoglobulin. To the best of our knowledge, this is the fourth case report of post-coronavirus disease 2019 vaccination precipitation of EGPA. All reported cases including our report were in patients with previous allergic manifestations who received mRNA-based coronavirus disease 2019 vaccines, and all the patients developed mononeuritis multiplex at presentation. Despite the few reported cases of post-vaccination autoimmune phenomena, the temporal association between vaccination administration and disease onset does not indicate causality, given the mass vaccination programmes employed. However, the novel use of the mRNA platform in vaccine delivery necessitates vigilant monitoring by the scientific committee.
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Affiliation(s)
- Salah Mahdi
- Department of Internal Medicine, Al-Khor Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Anwar I Joudeh
- Department of Internal Medicine, Al-Khor Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Samia Ait Faqih
- Department of Nephrology, Al-Khor Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Mohammed Akhtar
- Department of Laboratory Medicine and Pathology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abdo Qaid Ahmed Lutf
- Department of Internal Medicine, Al-Khor Hospital, Hamad Medical Corporation, Doha, Qatar
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3
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Hwang YK, Kwak HH, Yun JE, Kim SH, Chang YS. Eosinophilic Granulomatosis With Polyangiitis Following COVID-19 Vaccination: A Case Report. J Korean Med Sci 2023; 38:e382. [PMID: 38084026 PMCID: PMC10713438 DOI: 10.3346/jkms.2023.38.e382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/13/2023] [Indexed: 12/18/2023] Open
Abstract
The current emergence of the coronavirus disease 2019 (COVID-19) pandemic and the possible side effects of COVID-19 mRNA vaccination remain worrisome. Few cases of vaccination-related side effects, such as vasculitis, have been reported. Eosinophilic granulomatosis with polyangiitis (EGPA), also known as Churg-Strauss syndrome, is a type of vasculitis characterized by the histological richness of eosinophils, asthma, polyneuropathy, sinusitis, and skin or lung involvement. Here, we report the first case of new onset EGPA following COVID-19 vaccination in Korea. A 71-year old woman developed a skin rash and presented with progressive weakness of the upper and lower extremities after the BNT162b2 vaccination (Pfizer-BioNTech). She was diagnosed with EGPA and her symptoms improved after systemic steroid and immunosuppressant therapy. Although it is very rare, clinicians should be aware that EGPA may occur after COVID-19 vaccination.
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Affiliation(s)
- Yu-Kyoung Hwang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hui-Hwan Kwak
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jeong-Eun Yun
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sae-Hoon Kim
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Medical Research Center, Seoul National University, Seoul, Korea
| | - Yoon-Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Medical Research Center, Seoul National University, Seoul, Korea.
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4
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Jafarpour M, Daneshvar S, Eftekharsadat AT, Khabbazi A, Pourbagherian O. Eosinophilic granulomatosis with polyangiitis following flu guard influenza vaccination: A case report. Clin Case Rep 2023; 11:e8217. [PMID: 38028088 PMCID: PMC10675098 DOI: 10.1002/ccr3.8217] [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: 09/11/2023] [Revised: 10/17/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Key Clinical Message This case highlights a potential association between influenza vaccination and the development of eosinophilic granulomatosis with polyangiitis (EGPA), prompting the need for increased vigilance regarding vaccine-related autoimmune reactions. While causality remains unclear, clinicians should consider this possibility in patients presenting with EGPA-like symptoms shortly after vaccination. Abstract Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis characterized by tissue infiltration by eosinophils and hyper eosinophilia. We present a case of EGPA in a middle-aged man following influenza vaccination. The patient developed respiratory symptoms, skin lesions, joint pain, and neurological deficits. Diagnostic tests revealed eosinophilia, positive anti-neutrophil cytoplasmic antibodies, and elevated acute phase reactants. This report highlights a potential association between influenza vaccination and EGPA.
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Affiliation(s)
- Mehdi Jafarpour
- Connective Tissue Diseases Research CenterTabriz University of Medical SciencesTabrizIran
| | - Sara Daneshvar
- Connective Tissue Diseases Research CenterTabriz University of Medical SciencesTabrizIran
| | | | - Alireza Khabbazi
- Connective Tissue Diseases Research CenterTabriz University of Medical SciencesTabrizIran
| | - Omid Pourbagherian
- Immunology Research CenterTabriz University of Medical SciencesTabrizIran
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5
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Yang Y, Xiong Y, Xu G. New insights of antineutrophil cytoplasmic antibody-associated vasculitis from the perspective of COVID-19 vaccination. Clin Exp Immunol 2023; 213:301-309. [PMID: 37074008 PMCID: PMC10570996 DOI: 10.1093/cei/uxad043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/16/2023] [Accepted: 04/12/2023] [Indexed: 04/20/2023] Open
Abstract
The occurrence of antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) has been reported since the coronavirus disease 2019 (COVID-19) vaccination, but whether there is a causal relationship or coincidence remains to be verified. We combined the term COVID-19 vaccination with each word of AAV to search for case reports and case series published in PubMed, EMBASE, and Web of Science databases before 13 March 2023. A total of 56 patients who developed AAV after COVID-19 vaccination were identified from 44 research centers. Of the 56 subjects, 43 (76.7%) were vaccinated with the mRNA vaccine, followed by the adenovirus vaccine (14.3%) and inactivated vaccine (9.0%) (P = 0.015). Compared with relapsed AAV, new-onset AAV patients had at least two other diseases previously (P < 0.001). Twenty-five (44.6%) patients presented symptoms after the first injection, and the medium onset time was 12 (1-77) days, while Twenty-eight (50.0%) patients developed symptoms after the second dose, and their medium period was 14 (1-60) days. Forty-four (78.5%) patients achieved remission after immunosuppressive agents, plasma exchange, and hemodialysis. One (1.8%) patient died from progressive respiratory failure and nine (16.1%) did not recover, leaving five patients permanently dependent on hemodialysis. Pathogenic ANCA may be activated by enhanced immune response and epitope spreading after COVID-19 vaccination and induced the occurrence of AAV, especially in genetically susceptible populations.
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Affiliation(s)
- Yang Yang
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, PR China
| | - Yi Xiong
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, PR China
| | - Gaosi Xu
- Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, PR China
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Nune A, Durkowski V, Pillay SS, Barman B, Elwell H, Bora K, Bilgrami S, Mahmood S, Babajan N, Venkatachalam S, Ottewell L, Manzo C. New-Onset Rheumatic Immune-Mediated Inflammatory Diseases Following SARS-CoV-2 Vaccinations until May 2023: A Systematic Review. Vaccines (Basel) 2023; 11:1571. [PMID: 37896974 PMCID: PMC10610967 DOI: 10.3390/vaccines11101571] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023] Open
Abstract
A comprehensive, up-to-date systematic review (SR) of the new-onset rheumatic immune-mediated inflammatory diseases (R-IMIDs) following COVID-19 vaccinations is lacking. Therefore, we investigated the demographics, management, and prognosis of new R-IMIDs in adults following SARS-CoV-2 vaccinations. A systematic literature search of Medline, Embase, Google Scholar, LitCovid, and Cochrane was conducted. We included any English-language study that reported new-onset R-IMID in adults following the post-COVID-19 vaccination. A total of 271 cases were reported from 39 countries between January 2021 and May 2023. The mean age of patients was 56 (range 18-90), and most were females (170, 62.5%). Most (153, 56.5%) received the Pfizer BioNTech COVID-19 vaccine. Nearly 50% of patients developed R-IMID after the second dose of the vaccine. Vasculitis was the most prevalent clinical presentation (86, 31.7%), followed by connective tissue disease (66, 24.3%). The mean duration between the vaccine's 'trigger' dose and R-IMID was 11 days. Most (220, 81.2%) received corticosteroids; however, 42% (115) received DMARDs such as methotrexate, cyclophosphamide, tocilizumab, anakinra, IV immunoglobulins, plasma exchange, or rituximab. Complete remission was achieved in 75 patients (27.7%), and 137 (50.6%) improved following the treatment. Two patients died due to myositis. This SR highlights that SARS-CoV-2 vaccines may trigger R-IMID; however, further epidemiology studies are required.
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Affiliation(s)
- Arvind Nune
- Department of Rheumatology, Southport and Ormskirk NHS Trust, Southport PR8 6PN, UK
| | - Victor Durkowski
- Liverpool University Hospitals NHS Foundation Trust, Prescot Street, Liverpool L9 7AL, UK
| | | | - Bhupen Barman
- Department of General Medicine, All India Institute of Medical Sciences (AIIMS), Guwahati 781101, India
| | - Helen Elwell
- BMA Library, BMA House, Tavistock Square, British Medical Association, London WC1H 9JP, UK
| | - Kaustubh Bora
- Haematology Division, ICMR-Regional Medical Research Centre, Dibrugarh 786001, India
| | - Syed Bilgrami
- Department of Rheumatology, Royal Lancaster Infirmary, Lancaster LA1 4RP, UK
| | - Sajid Mahmood
- Department of Medicine, Southport and Ormskirk Hospital NHS Trust, Southport PR8 6PN, UK
| | - Nasarulla Babajan
- Department of Medicine, Southport and Ormskirk Hospital NHS Trust, Southport PR8 6PN, UK
| | | | - Lesley Ottewell
- Department of Rheumatology, Royal Lancaster Infirmary, Lancaster LA1 4RP, UK
| | - Ciro Manzo
- Rheumatologic Outpatient Clinic, Azienda Sanitaria Locale Napoli 3, 80065 Sant'Agnello, Italy
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7
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Caputo A, Caleo A, Cozzolino I, Zeppa P, Ciancia G, Ciliberti V. COVID-19 post-vaccination lymphadenopathy: A review of the use of fine needle aspiration cytology. Cytopathology 2023; 34:423-432. [PMID: 36807950 DOI: 10.1111/cyt.13221] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/20/2023]
Abstract
COVID-19 vaccine-associated clinical lymphadenopathy (C19-LAP) and subclinical lymphadenopathy (SLDI), which are mainly detected by 18F-FDG PET-CT, have been observed after the introduction of RNA-based vaccines during the pandemic. Lymph node (LN) fine needle aspiration cytology (FNAC) has been used to diagnose single cases or small series of SLDI and C19-LAP. In this review, clinical and LN-FNAC features of SLDI and C19-LAP are reported and compared to non-Covid (NC)-LAP. A search for studies on C19-LAP and SLDI histopathology and cytopathology was performed on PubMed and Google Scholar, on 11 January 2023. Reports on LN-FNAC of C19-LAP were retrieved. A total of 14 reports, plus one unpublished case of C19-LAP observed in our institution, diagnosed by LN-FNAC were included in a pooled analysis and compared to the corresponding histopathological reports. In total, 26 cases were included in this review, with a mean age of 50.5 years. Twenty-one lymphadenopathies assessed by LN-FNAC were diagnosed as benign, and three cases as atypical lymphoid hyperplasia; the latter were subsequently confirmed as benign (one by repetition of LN-FNAC, two by histological control). One case of mediastinal lymphadenopathy in a patient suffering from melanoma was reported as reactive granulomatous inflammation, while one unsuspected case was diagnosed as metastasis from melanoma. In all cases, the cytological diagnoses were confirmed by follow-up or excisional biopsy. The high diagnostic value of LN-FNAC in excluding malignant processes was extremely useful in this context and may be particularly valuable when CNB or histological excisions are difficult to perform, as was the case during Covid lockdowns.
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Affiliation(s)
- Alessandro Caputo
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria, San Giovanni di Dio e Ruggi d'Aragona, University of Salerno (IT), Salerno, Italy
| | - Alessia Caleo
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria, San Giovanni di Dio e Ruggi d'Aragona, University of Salerno (IT), Salerno, Italy
| | - Immacolata Cozzolino
- Dipartimento di Salute Mentale e Fisica e Medicina, Università degli studi della Campania Luigi Vanvitelli, Naples (IT), Naples, Italy
| | - Pio Zeppa
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria, San Giovanni di Dio e Ruggi d'Aragona, University of Salerno (IT), Salerno, Italy
| | - Giuseppe Ciancia
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria, San Giovanni di Dio e Ruggi d'Aragona, University of Salerno (IT), Salerno, Italy
| | - Valeria Ciliberti
- UOC di Anatomia Patologica, Azienda Ospedaliera Universitaria, San Giovanni di Dio e Ruggi d'Aragona, University of Salerno (IT), Salerno, Italy
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Mencarelli L, Moi L, Dewarrat N, Monti M, Alberio L, Ringwald M, Swierdzewska K, Panagiotis A, Ribi C. Eosinophilic Granulomatosis with Polyangiitis after mRNA-1273 SARS-CoV-2 Vaccine. Vaccines (Basel) 2023; 11:1335. [PMID: 37631903 PMCID: PMC10457893 DOI: 10.3390/vaccines11081335] [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: 07/11/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/29/2023] Open
Abstract
During one of the worst global health crises, millions of people were vaccinated against SARS-CoV-2. In rare cases, new onset systemic inflammatory diseases were reported with temporal coincidence to the vaccination. We describe a case of severe Eosinophilic Granulomatosis with Polyangiitis (EGPA) in a young asthmatic woman, occurring after a second dose of the mRNA-1273 vaccine. She presented with multisystem EGPA with cardiac and central nervous system involvement, complicated by secondary immune thrombocytopenia (ITP). We review the reported cases of EGPA coinciding with SARS-CoV-2 mRNA vaccination. All potentially vaccine-related EGPA cases reported so far occurred within 14 days from immunization. EGPA is very rare with an incidence of 1:1,000,000 inhabitants, and the number of reported post-vaccination EGPA cases lies within the expected incidence rate for the period. While we cannot prove a causal relationship between the vaccine and EGPA onset, the temporal relationship with the vaccine immune stimulation is intriguing, in a disease occurring almost always in adults with asthma and/or chronic rhinosinusitis and driven by an aberrant Th2 lymphocyte activation with hypereosinophilia; nevertheless, cases of inflammatory diseases (IMIDs) emerging in the context of vaccination remain rare and the benefits of preventing severe COVID presentations with SARS-CoV-2 mRNA vaccines remain unquestionable.
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Affiliation(s)
- Lucrezia Mencarelli
- Division of Internal Medicine, Department of Medicine, Lausanne University Hospital, Lausanne University, 1011 Lausanne, Switzerland
| | - Laura Moi
- Division of Immunology and Allergology, Institut Central des Hôpitaux du Valais, 1951 Sion, Switzerland
| | - Natacha Dewarrat
- Division of Haematology and Central Laboratory of Hematology, Lausanne University Hospital, Lausanne University, 1011 Lausanne, Switzerland
| | - Matteo Monti
- Division of Internal Medicine, Department of Medicine, Lausanne University Hospital, Lausanne University, 1011 Lausanne, Switzerland
| | - Lorenzo Alberio
- Division of Haematology and Central Laboratory of Hematology, Lausanne University Hospital, Lausanne University, 1011 Lausanne, Switzerland
| | - Maxime Ringwald
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital, Lausanne University, 1011 Lausanne, Switzerland (C.R.)
| | - Karolina Swierdzewska
- Division of Diagnostic Radiology, Department of Radiology, Lausanne University Hospital, Lausanne University, 1011 Lausanne, Switzerland
| | - Antiochos Panagiotis
- Division of Cardiology, Department of Heart and Vessels, Lausanne University Hospital, Lausanne University, 1011 Lausanne, Switzerland
| | - Camillo Ribi
- Division of Immunology and Allergy, Department of Medicine, Lausanne University Hospital, Lausanne University, 1011 Lausanne, Switzerland (C.R.)
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9
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Fijolek J, Radzikowska E. Eosinophilic granulomatosis with polyangiitis - Advances in pathogenesis, diagnosis, and treatment. Front Med (Lausanne) 2023; 10:1145257. [PMID: 37215720 PMCID: PMC10193253 DOI: 10.3389/fmed.2023.1145257] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/13/2023] [Indexed: 05/24/2023] Open
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare disease characterized by eosinophil-rich granulomatous inflammation and necrotizing vasculitis, pre-dominantly affecting small-to-medium-sized vessels. It is categorized as a primary antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAVs) but also shares features of hypereosinophilic syndrome (HES); therefore, both vessel inflammation and eosinophilic infiltration are suggested to cause organ damage. This dual nature of the disease causes variable clinical presentation. As a result, careful differentiation from mimicking conditions is needed, especially from HES, given the overlapping clinical, radiologic, and histologic features, and biomarker profile. EGPA also remains a diagnostic challenge, in part because of asthma, which may pre-dominate for years, and often requires chronic corticosteroids (CS), which can mask other disease features. The pathogenesis is still not fully understood, however, the interaction between eosinophils and lymphocytes B and T seems to play an important role. Furthermore, the role of ANCA is not clear, and only up to 40% of patients are ANCA-positive. Moreover, two ANCA-dependent clinically and genetically distinct subgroups have been identified. However, a gold standard test for establishing a diagnosis is not available. In practice, the disease is mainly diagnosed based on the clinical symptoms and results of non-invasive tests. The unmet needs include uniform diagnostic criteria and biomarkers to help distinguish EGPA from HESs. Despite its rarity, notable progress has been made in understanding the disease and in its management. A better understanding of the pathophysiology has provided new insights into the pathogenesis and therapeutic targets, which are reflected in novel biological agents. However, there remains an ongoing reliance on corticosteroid therapy. Therefore, there is a significant need for more effective and better-tolerated steroid-sparing treatment schemes.
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10
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Tachibana Y, Yamada T, Tsuji T, Murai J, Takayama K. A Case of Takotsubo Cardiomyopathy Triggered by Asthma Exacerbation After mRNA-based Vaccination for COVID-19. Cureus 2023; 15:e39499. [PMID: 37362462 PMCID: PMC10290556 DOI: 10.7759/cureus.39499] [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: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
It is recommended to get the multiple coronavirus disease 2019 (COVID-19) vaccinations for almost all people including asthma patients. A 70-year-old Japanese woman with asthma experienced worsening of respiratory symptoms after the second dose of the mRNA-based COVID-19 vaccine BNT162b2. The patient had hypercapnic respiratory failure and cardiac-apex ballooning and was diagnosed with takotsubo cardiomyopathy induced by asthma exacerbation. Therapies for asthma exacerbation resulted in prompt improvement of respiratory failure and cardiac-apex ballooning. Our findings suggest that asthma patients are prone to exacerbations after receiving the COVID-19 vaccination; therefore, stratification of the patients at risk is required.
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Affiliation(s)
- Yusuke Tachibana
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, JPN
| | - Tadaaki Yamada
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, JPN
| | - Taisuke Tsuji
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, JPN
| | - Junji Murai
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, JPN
| | - Koichi Takayama
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, JPN
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11
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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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12
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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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Mohideen H, Weldemichael W, Hussain H, Dahiya DS, Shin A. Gastrointestinal Eosinophilic Granulomatosis with Polyangiitis following a Clostridium difficile Infection. Case Rep Gastroenterol 2023; 17:228-234. [PMID: 37383985 PMCID: PMC10294265 DOI: 10.1159/000530373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 03/06/2023] [Indexed: 06/30/2023] Open
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA), historically named Churg-Strauss syndrome, is a rare vasculitis affecting small- and medium-sized blood vessels. The disease has a predilection for numerous organs including the lungs, sinuses, kidneys, heart, nerves, and gastrointestinal tract but is prominently associated with asthma, rhinosinusitis, and eosinophilia. Gastrointestinal involvement is common; however, a gastrointestinal manifestation as the cardinal symptom following an infection is atypical. Here, we present a case of a 61-year-old male who presented with persistent diarrhea following a toxigenic Clostridium difficile infection despite multiple antibiotic courses. Repeat testing confirmed eradication of the infection, and further evaluation with colon biopsy revealed small and medium-sized vasculitis with eosinophilic infiltration and granulomas. Treatment with prednisone and cyclophosphamide resulted in rapid improvement of his diarrhea. Gastrointestinal symptoms in EGPA are associated with worse prognosis, so prompt identification and treatment of the disease is crucial. EGPA is rarely documented in histopathological samples from the gastrointestinal tract as endoscopic biopsies are typically too superficial to sample the submucosal layer containing the affected vessels. Additionally, the link between EGPA and infections as a potential trigger has not been clearly established, but gastrointestinal EGPA manifesting after a colonic infection raises concerns that this may have been a triggering event. Ultimately, further study is needed to understand, diagnose, and treat gastrointestinal and postinfection EGPA.
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Affiliation(s)
- Haseeb Mohideen
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Wegahta Weldemichael
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Hafsa Hussain
- Northeast Ohio Medical University, Rootstown, OH, USA
| | | | - Andrea Shin
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
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Belov BS, Egorova ON, Tarasova GM, Muravieva NV. Infections and systemic vasculitis. MODERN RHEUMATOLOGY JOURNAL 2022. [DOI: 10.14412/1996-7012-2022-5-75-81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Infections and systemic vasculitis (SV) are characterized by mutual influence, which increases the risk of occurrence, aggravates the course and outcome of the disease. The review considers the issues related to both the trigger role of infections in the development of SV and comorbid infections (CI) that complicate the course of the disease. Recognition of the infectious etiology of SV is of great importance, since it requires a comprehensive examination and, if necessary, early and complete etiotropic treatment. Since SV per se and the use of both induction and maintenance immunosuppressive therapy are significant risk factors for secondary CIs, special attention should be paid to the prevention of the latter, including vaccination, primarily against influenza and pneumococcal infections.
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Affiliation(s)
- B. S. Belov
- V.A. Nasonova Research Institute of Rheumatology
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