Cargando…

A Case of Giant Cell Arteritis Presenting After COVID-19 Vaccination: Is It Just a Coincidence?

Giant cell arteritis (GCA) is a large vessel vasculitis with variable presentations, including fevers, myalgias, headache, and jaw claudication. A particularly concerning symptom is transient vision loss, which may become irreversible without prompt recognition and treatment. The pathogenesis of GCA...

Descripción completa

Detalles Bibliográficos
Autores principales: Greb, Christopher S, Aouhab, Zineb, Sisbarro, Daniel, Panah, Elnaz
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8873313/
https://www.ncbi.nlm.nih.gov/pubmed/35228965
http://dx.doi.org/10.7759/cureus.21608
_version_ 1784657437177937920
author Greb, Christopher S
Aouhab, Zineb
Sisbarro, Daniel
Panah, Elnaz
author_facet Greb, Christopher S
Aouhab, Zineb
Sisbarro, Daniel
Panah, Elnaz
author_sort Greb, Christopher S
collection PubMed
description Giant cell arteritis (GCA) is a large vessel vasculitis with variable presentations, including fevers, myalgias, headache, and jaw claudication. A particularly concerning symptom is transient vision loss, which may become irreversible without prompt recognition and treatment. The pathogenesis of GCA is incompletely understood, but it seems that the innate and adaptive immune systems play a key role in vessel inflammation, remodeling, and occlusion. We present a case of a 79-year-old male who developed GCA two days after he received his second dose of a COVID-19 mRNA vaccine. He presented with headaches, fever, and myalgias. Lab workup revealed elevated inflammatory markers, with C-reactive protein (CRP) 272 mg/L (<8.1 mg/L) and erythrocyte sedimentation rate (ESR) 97 mm/hr (0-20mm/hr). Imaging of the head, with CT and MRI, was unremarkable. His headache persisted despite supportive treatment, and he developed new, transient blurred vision, which increased suspicion for GCA. He underwent bilateral temporal artery biopsies, which were consistent with GCA. His symptoms resolved quickly with oral prednisone 60mg daily, and his inflammatory markers returned to normal within a month. A review of the literature revealed several case reports of giant cell arteritis following influenza vaccination. However, no large-scale studies have demonstrated a causal relationship between GCA and immunization. Our case demonstrates the first instance of GCA following a COVID-19 mRNA vaccine. We propose that the upregulated immune response to the vaccine acted as a trigger for GCA in this patient with predisposing factors. While causation cannot be determined based on one case alone, our case demonstrates an opportunity for further research into the relationship between vasculitis and immunizations. Despite this isolated case, the proven benefits of COVID-19 mRNA vaccines significantly outweigh any theoretical risk of immune dysregulation following administration.
format Online
Article
Text
id pubmed-8873313
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Cureus
record_format MEDLINE/PubMed
spelling pubmed-88733132022-02-27 A Case of Giant Cell Arteritis Presenting After COVID-19 Vaccination: Is It Just a Coincidence? Greb, Christopher S Aouhab, Zineb Sisbarro, Daniel Panah, Elnaz Cureus Allergy/Immunology Giant cell arteritis (GCA) is a large vessel vasculitis with variable presentations, including fevers, myalgias, headache, and jaw claudication. A particularly concerning symptom is transient vision loss, which may become irreversible without prompt recognition and treatment. The pathogenesis of GCA is incompletely understood, but it seems that the innate and adaptive immune systems play a key role in vessel inflammation, remodeling, and occlusion. We present a case of a 79-year-old male who developed GCA two days after he received his second dose of a COVID-19 mRNA vaccine. He presented with headaches, fever, and myalgias. Lab workup revealed elevated inflammatory markers, with C-reactive protein (CRP) 272 mg/L (<8.1 mg/L) and erythrocyte sedimentation rate (ESR) 97 mm/hr (0-20mm/hr). Imaging of the head, with CT and MRI, was unremarkable. His headache persisted despite supportive treatment, and he developed new, transient blurred vision, which increased suspicion for GCA. He underwent bilateral temporal artery biopsies, which were consistent with GCA. His symptoms resolved quickly with oral prednisone 60mg daily, and his inflammatory markers returned to normal within a month. A review of the literature revealed several case reports of giant cell arteritis following influenza vaccination. However, no large-scale studies have demonstrated a causal relationship between GCA and immunization. Our case demonstrates the first instance of GCA following a COVID-19 mRNA vaccine. We propose that the upregulated immune response to the vaccine acted as a trigger for GCA in this patient with predisposing factors. While causation cannot be determined based on one case alone, our case demonstrates an opportunity for further research into the relationship between vasculitis and immunizations. Despite this isolated case, the proven benefits of COVID-19 mRNA vaccines significantly outweigh any theoretical risk of immune dysregulation following administration. Cureus 2022-01-25 /pmc/articles/PMC8873313/ /pubmed/35228965 http://dx.doi.org/10.7759/cureus.21608 Text en Copyright © 2022, Greb et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Allergy/Immunology
Greb, Christopher S
Aouhab, Zineb
Sisbarro, Daniel
Panah, Elnaz
A Case of Giant Cell Arteritis Presenting After COVID-19 Vaccination: Is It Just a Coincidence?
title A Case of Giant Cell Arteritis Presenting After COVID-19 Vaccination: Is It Just a Coincidence?
title_full A Case of Giant Cell Arteritis Presenting After COVID-19 Vaccination: Is It Just a Coincidence?
title_fullStr A Case of Giant Cell Arteritis Presenting After COVID-19 Vaccination: Is It Just a Coincidence?
title_full_unstemmed A Case of Giant Cell Arteritis Presenting After COVID-19 Vaccination: Is It Just a Coincidence?
title_short A Case of Giant Cell Arteritis Presenting After COVID-19 Vaccination: Is It Just a Coincidence?
title_sort case of giant cell arteritis presenting after covid-19 vaccination: is it just a coincidence?
topic Allergy/Immunology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8873313/
https://www.ncbi.nlm.nih.gov/pubmed/35228965
http://dx.doi.org/10.7759/cureus.21608
work_keys_str_mv AT grebchristophers acaseofgiantcellarteritispresentingaftercovid19vaccinationisitjustacoincidence
AT aouhabzineb acaseofgiantcellarteritispresentingaftercovid19vaccinationisitjustacoincidence
AT sisbarrodaniel acaseofgiantcellarteritispresentingaftercovid19vaccinationisitjustacoincidence
AT panahelnaz acaseofgiantcellarteritispresentingaftercovid19vaccinationisitjustacoincidence
AT grebchristophers caseofgiantcellarteritispresentingaftercovid19vaccinationisitjustacoincidence
AT aouhabzineb caseofgiantcellarteritispresentingaftercovid19vaccinationisitjustacoincidence
AT sisbarrodaniel caseofgiantcellarteritispresentingaftercovid19vaccinationisitjustacoincidence
AT panahelnaz caseofgiantcellarteritispresentingaftercovid19vaccinationisitjustacoincidence