Hugues Benjamin, Ben Amer Hakim, Bril Floriane, Groh Matthieu, Huang Florent
Service de Médecine Interne, Hôpital Foch, Suresnes, France.
Service de Cardiologie, Hôpital Foch, Suresnes, France.
Eur J Case Rep Intern Med. 2022 Aug 29;9(8):003469. doi: 10.12890/2022_003469. eCollection 2022.
Several immune-mediated side effects have been reported with COVID-19 vaccines, including myocarditis.
A 27-year-old woman with a past medical history of mild COVID-19, developed adult-onset Still's disease (AOSD) with salmon-pink flagellate erythema, polyarthritis, a sore throat, myocarditis and haemophagocytic lymphohistiocytosis after receiving two doses of the BNT162b2 vaccine (Pfizer, BioNTech). Despite the initial efficacy of high-dose pulses of methylprednisolone, inflammatory markers rose as soon as de-escalation of corticosteroids was attempted, warranting initiation of biologics targeting the interleukin (IL)-1/6 axis, which allowed sustained remission of the disease despite withdrawal of corticosteroids.
To our knowledge, this is the first case of AOSD with both haemophagocytic lymphohistiocytosis and cardiac magnetic resonance imaging-proven myocarditis triggered by COVID-19 vaccination, successfully treated with steroids and biologics targeting the IL-1/IL-6 axis. The pathophysiological process by which COVID-19 vaccination can lead to AOSD is still unknown, although it has been reported that the spike protein may act as a pathogen-associated molecular pattern and thus induce an overproduction of pro-inflammatory cytokines of the innate immune system (e.g., IL-1, IL-6 or IL-18).
Targeting the IL-1/6 axis is effective for the treatment of severe steroid-refractory BNT162b2 vaccine-induced adult-onset Still's disease. At a population level, the favourable benefit/risk ratio of COVID-19 vaccination remains indisputable.
Adult-onset Still's disease can be triggered by the BNT162b2 COVID-19 vaccine.Biologics targeting the interleukin-1/6 axis should be considered early in the course of vaccine-induced adult-onset Still's disease, especially when steroids do not effectively curb the disease.
已有报道称新冠疫苗会引发多种免疫介导的副作用，包括心肌炎。
一名27岁女性，既往有轻度新冠病史，在接种两剂BNT162b2疫苗（辉瑞、BioNTech）后，出现了成人斯蒂尔病（AOSD），伴有鲑鱼粉红色鞭状红斑、多关节炎、咽痛、心肌炎和噬血细胞性淋巴组织细胞增生症。尽管大剂量甲基强的松龙脉冲治疗起初有效，但一旦尝试减少皮质类固醇剂量，炎症指标就会上升，这使得有必要启动针对白细胞介素（IL）-1/6轴的生物制剂治疗，尽管停用了皮质类固醇，该生物制剂仍使疾病持续缓解。
据我们所知，这是首例由新冠疫苗引发的同时伴有噬血细胞性淋巴组织细胞增生症和心脏磁共振成像证实的心肌炎的成人斯蒂尔病病例，通过使用类固醇和针对IL-1/IL-6轴的生物制剂成功治愈。尽管有报道称刺突蛋白可能作为一种病原体相关分子模式，从而诱导先天性免疫系统促炎细胞因子（如IL-1、IL-6或IL-18）过度产生，但新冠疫苗接种导致成人斯蒂尔病的病理生理过程仍不清楚。
针对IL-1/6轴治疗严重的类固醇难治性BNT162b2疫苗诱导的成人斯蒂尔病有效。在人群层面，新冠疫苗接种有利的效益/风险比仍然无可争议。
成人斯蒂尔病可由BNT162b2新冠疫苗引发。在疫苗诱导的成人斯蒂尔病病程早期应考虑使用针对白细胞介素-1/6轴的生物制剂，尤其是在类固醇不能有效控制疾病时。
