Lin Ting-Yu, Yeh Yun-Hsuan, Chen Li-Wen, Cheng Chao-Neng, Chang Chen, Roan Jun-Neng, Shen Ching-Fen
Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City 704, Taiwan.
Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City 704, Taiwan.
Vaccines (Basel). 2022 Apr 8;10(4):573. doi: 10.3390/vaccines10040573.
Although serious adverse events have remained uncommon, cases of myocarditis induced by messenger RNA (mRNA) COVID-19 vaccines have been reported. Here, we presented a rare but potentially fatal disorder, hemophagocytic lymphohistiocytosis, in a 14-year-old previously healthy adolescent after BNT162b2 mRNA vaccination. The initial evaluation showed splenomegaly, pancytopenia, hyperferritinemia, and hypofibrinogenemia. Further examination revealed positive blood EBV DNA, and other infectious pathogen surveys were all negative. Hemophagocytosis was observed in the bone marrow aspiration and biopsy. HLH was confirmed and intravenous immunoglobulin (IVIG) and methylprednisolone pulse therapy were given. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) was set up for cardiopulmonary support for 3 days due to profound hypotension. The patient was kept on oral prednisolone treatment for 28 days with the following gradual tapering. The hemogram and inflammatory biomarkers gradually returned to normal, and the patient was discharged. The fulminant presentation of HLH in our case could be the net result of both acute immunostimulation after COVID-19 vaccination and EBV infection. Our case suggests that the immune activation after COVID-19 vaccination is likely to interfere with the adequate immune response to certain infectious pathogens, resulting in a hyperinflammatory syndrome.
尽管严重不良事件仍然不常见，但已有信使核糖核酸（mRNA）新冠疫苗诱发心肌炎的病例报道。在此，我们报告了1例罕见但可能致命的疾病——噬血细胞性淋巴组织细胞增生症，发生在1名14岁既往健康的青少年接种BNT162b2 mRNA疫苗之后。初始评估显示脾肿大、全血细胞减少、高铁蛋白血症和低纤维蛋白原血症。进一步检查发现血液EBV DNA阳性，其他感染性病原体检测均为阴性。骨髓穿刺和活检观察到噬血细胞现象。确诊为噬血细胞性淋巴组织细胞增生症（HLH），给予静脉注射免疫球蛋白（IVIG）和甲泼尼龙冲击治疗。由于严重低血压，进行了3天的静脉-动脉体外膜肺氧合（VA-ECMO）以提供心肺支持。患者接受口服泼尼松龙治疗28天，随后逐渐减量。血常规和炎症生物标志物逐渐恢复正常，患者出院。我们病例中HLH的暴发性表现可能是新冠疫苗接种后急性免疫刺激和EBV感染共同作用的结果。我们的病例表明，新冠疫苗接种后的免疫激活可能会干扰对某些感染性病原体的充分免疫反应，从而导致高炎症综合征。
