Multisystem Inflammation and Organ Dysfunction After BNT162b2 Messenger RNA Coronavirus Disease 2019 Vaccination

Supplemental Digital Content is available in the text. BACKGROUND: The U.S. Food and Drug Administration has to date granted approval or emergency use authorization to three vaccines against severe acute respiratory syndrome coronavirus 2 and coronavirus disease 2019. In clinical trials and real-use...

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Veröffentlicht in:Critical care explorations Jg. 3; H. 11; S. e0578
Hauptverfasser: Kahn, Benjamin, Apostolidis, Sokratis A., Bhatt, Vatsal, Greenplate, Allison R., Kallish, Staci, LaCava, Anthony, Lucas, Alfredo, Meyer, Nuala J., Negoianu, Dan, Ogdie, Alexis R., Shashaty, Michael G. S., Takach, Patricia A., Zuroff, Leah, Wherry, E. John, Anesi, George L.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: Hagerstown, MD Lippincott Williams & Wilkins 05.11.2021
Wolters Kluwer
Schlagworte:
Case Report
adverse event
inflammation
coronavirus disease 2019
multisystem organ dysfunction
vaccination
ISSN:2639-8028, 2639-8028
Online-Zugang:Volltext
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Zusammenfassung:Supplemental Digital Content is available in the text. BACKGROUND: The U.S. Food and Drug Administration has to date granted approval or emergency use authorization to three vaccines against severe acute respiratory syndrome coronavirus 2 and coronavirus disease 2019. In clinical trials and real-use observational studies, the Pfizer-BioNTech BNT162b2 messenger RNA coronavirus disease 2019 vaccine, as well as the Moderna mRNA-1273 messenger RNA coronavirus disease 2019 vaccine, have demonstrated high efficacy and few adverse events. CASE SUMMARY: A 20-year-old male college student in good health developed tinnitus and hematuria shortly after vaccination and progressed swiftly to a syndrome of: systemic inflammation; acute kidney injury requiring hemodialysis; acute, bilateral, complete sensorineural hearing loss; radiographic evidence of acute multifocal ischemic strokes; pericardial effusion complicated by tamponade physiology requiring pericardial evacuation; pleural effusions requiring evacuation; and systemic capillary leak. An extensive clinical and research investigation, including cytokine analysis, whole blood cytometry by time of flight, and whole exome sequencing, did not reveal a definitive explanatory mechanism. CONCLUSION: While the overall safety profile of the BNT162b2 coronavirus disease 2019 vaccine remains excellent for the general population, rare serious events have been reported. In this report, we describe a case of multisystem inflammation and organ dysfunction of unknown mechanism beginning shortly after administration of the first dose of BNT162b2 coronavirus disease 2019 vaccine in a previously healthy recipient.
Bibliographie:Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://journals.lww.com/ccejournal). Supported, in part, by grant from Agency for Healthcare Research and Quality K12HS026372 (to Dr. Anesi); National Institute of Arthritis and Musculoskeletal and Skin Diseases T32AR076951 (to Dr. Apostolidis); National Institute of Allergy and Infectious Diseases AI082630 (to Dr. Wherry); University of Pennsylvania Perelman School of Medicine Coronavirus Disease Fund (to Dr. Wherry); University of Pennsylvania Institute for Immunology (to Drs. Apostolidis and Wherry). Work in the Wherry lab is supported by the Parker Institute for Cancer Immunotherapy. Dr. Anesi receives research funding from Agency for Healthcare Research and Quality and reports payments for authoring coronavirus disease 2019 chapters for UpToDate and for expert witness consulting. Dr. Wherry is consulting or is an advisor for Merck, Marengo, Janssen, Related Sciences, Synthekine, and Surface Oncology; he is a founder of Danger Bio, Surface Oncology, and Arsenal Biosciences; and he is an inventor on a patent (U.S. Patent number 10,370,446) submitted by Emory University that covers the use of programmed cell death protein 1 blockade to treat infections and cancer. The content is solely the responsibility of the authors and does not necessarily represent the official views of any funders including the Agency for Healthcare Research and Quality. For information regarding this article, E-mail: george.anesi@pennmedicine.upenn.edu
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ISSN:2639-8028
2639-8028
DOI:10.1097/CCE.0000000000000578