Lv Yuqing, Chang Ying
Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.
Vaccines (Basel). 2022 Aug 29;10(9):1417. doi: 10.3390/vaccines10091417.
(1) Background: We describe a case of a 58-year-old Chinese woman, without obvious cause of immunosuppression, who developed cytomegalovirus (CMV) proctitis three days after a second COVID-19 vaccination. Electronic colonoscopy revealed a new lesion that was circumferential at the anorectal junction, with an uneven surface and ulceration, which mimicked rectal carcinoma. This is the first case of CMV proctitis following vaccination since the invention of the COVID-19 vaccine, suggesting that the COVID-19 vaccine may cause disorders of immune homeostasis, including not only immune hyperactivity but also immune deficiency. We report this case to increase readers' awareness of the risks after COVID-19 vaccination and to provide new ideas for the diagnosis and treatment of similar cases. (2) Methods: In this case, we used laboratory biochemical examinations, colonoscopy, immunohistochemistry, and a biochemical index to confirm the existence of CMV proctitis. (3) Results: In this case, the vaccine-induced CMV proctitis had a similar endoscopic appearance to rectal neoplastic lesions, which could be confirmed by biopsy and quickly relieved by ganciclovir treatment. Ganciclovir was used to treat the patient, and a good effect was observed. (4) Conclusions: COVID-19 vaccination may cause immune disorders, not just immune hyperactivity as previously reported, but also immune deficiency, such as CMV proctitis in this case. The clinical course of CMV proctitis secondary to COVID-19 vaccination was favorable with ganciclovir therapy.
(1) 背景：我们描述了一例58岁的中国女性病例，该患者无明显免疫抑制原因，在第二次接种新冠疫苗三天后发生了巨细胞病毒（CMV）直肠炎。电子结肠镜检查发现一个新病变，位于肛管直肠交界处，呈环形，表面不平整且有溃疡，类似直肠癌。这是新冠疫苗发明以来首例接种疫苗后发生的CMV直肠炎病例，提示新冠疫苗可能导致免疫稳态紊乱，不仅包括免疫亢进，还包括免疫缺陷。我们报告此病例以提高读者对新冠疫苗接种后风险的认识，并为类似病例的诊断和治疗提供新思路。(2) 方法：在该病例中，我们采用实验室生化检查、结肠镜检查、免疫组织化学及一项生化指标来确诊CMV直肠炎的存在。(3) 结果：在该病例中，疫苗诱导的CMV直肠炎内镜表现与直肠肿瘤性病变相似，可通过活检确诊，并经更昔洛韦治疗后迅速缓解。使用更昔洛韦治疗该患者，观察到良好效果。(4) 结论：新冠疫苗接种可能导致免疫紊乱，不仅如先前报道的免疫亢进，还包括免疫缺陷，如此病例中的CMV直肠炎。经更昔洛韦治疗，新冠疫苗接种继发的CMV直肠炎临床病程良好。
