Nappi Emanuele, De Santis Maria, Paoletti Giovanni, Pelaia Corrado, Terenghi Fabrizia, Pini Daniela, Ciccarelli Michele, Selmi Carlo Francesco, Puggioni Francesca, Canonica Giorgio Walter, Heffler Enrico
Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy.
IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy.
Vaccines (Basel). 2022 May 3;10(5):716. doi: 10.3390/vaccines10050716.
Anti-SARS-CoV-2 vaccines are safe and effective, also in individuals with allergic and immune-mediated diseases (IMDs). There are reports suggesting that vaccines may be able to trigger de-novo or exacerbate pre-existing IMDs in predisposed individuals. Eosinophilic granulomatosis with polyangiitis (EGPA) is a small-vessel vasculitis characterized by asthma, eosinophilia, and eosinophil-rich granulomatous inflammation in various tissues. We describe the case of a 63-year-old man who experienced cardiac, pulmonary, and neurological involvement one day after the administration of the booster dose of anti-SARS-CoV-2 vaccine (mRNA-1273). A diagnosis of EGPA was made and the patient was treated with high-dose steroids and cyclophosphamide, with a good clinical response. Interestingly, our patient had experienced a significant worsening of his pre-existing asthma six months earlier, just after the first two vaccine shots with the ChAdOx1 anti-SARS-CoV-2 vaccine. It is impossible to know whether our patient would have had developed EGPA following natural SARS-CoV-2 infection or at some point in his life regardless of infectious stimuli. Nevertheless, our report may suggest that caution should be paid during the administration of additional vaccine doses in individuals who experienced an increase in IMD severity that persisted over time following previous vaccine shots.
抗SARS-CoV-2疫苗是安全有效的，对于患有过敏性疾病和免疫介导疾病（IMD）的个体也是如此。有报告表明，疫苗可能会在易感个体中引发新发的IMD或加重既往存在的IMD。嗜酸性肉芽肿性多血管炎（EGPA）是一种小血管血管炎，其特征为哮喘、嗜酸性粒细胞增多以及在各种组织中出现富含嗜酸性粒细胞的肉芽肿性炎症。我们描述了一名63岁男性的病例，该患者在接种抗SARS-CoV-2疫苗（mRNA-1273）加强针一天后出现心脏、肺部和神经系统受累。诊断为EGPA，患者接受了高剂量类固醇和环磷酰胺治疗，临床反应良好。有趣的是，我们的患者在六个月前，即在首次接种两剂ChAdOx1抗SARS-CoV-2疫苗后，其既往存在的哮喘病情显著恶化。无法确定我们的患者在自然感染SARS-CoV-2后或在其生命中的某个时刻，无论是否有感染刺激，是否会发生EGPA。然而，我们的报告可能提示，对于既往接种疫苗后IMD严重程度随时间持续增加的个体，在接种额外剂量疫苗时应谨慎。
