Gabrielli Roberto, Siani Andrea, Smedile Gianluca, Rizzo Anna Rita, De Vivo Gennaro, Accrocca Federico, Bartoli Stefano
Unit of Vascular, Endovascular and Emergency Vascular Surgery, "S. Eugenio" Hospital, Rome, Italy.
Vascular. 2024 Feb;32(1):226-230. doi: 10.1177/17085381221126234. Epub 2022 Oct 6.
Giant cell arteritis (GCA) is a rare granulomatous vasculitis, affecting medium and large vessels, usually in old patients. The incidence of GCA has been higher during current COVID-19 pandemia and COVID-19 is recognized for its immune dysregulation. Lower limbs involvement is uncommon but can be limb threatening, resulting in limb loss.
A 43-year-old man presented with a sudden pain in his right calf and foot associated with pallor and hypothermia, and there was objective evidence of ischemia. Symptoms began few days after he received the first dose of a COVID-19 mRNA vaccine and COVID-19 asymptomatic infection 20 days after vaccination. He had no history of any signs of claudication pre-COVID or limb trauma and was very fit.Enhanced computed tomography and magnetic resonance imaging (MRI)suggest diagnosis of popliteal artery cystic adventitial disease. We resected the affected popliteal artery with interposition using a right great saphenous vein graft, through a posterior approach. On the fourth postoperative day, he was discharged.Histopathological examination revealed patchy intramural inflammatory infiltrates composed of lymphocytes and rare multinucleated giant cells at the internal lamina and adventitia consistent with a diagnosis of GCA.
Our case represents the first reported case of isolated popliteal GCA following vaccination with a COVID-19 mRNA vaccine and COVID-19 infection. We propose that the upregulated immune response to the vaccine acted as a trigger for GCA in this patient with predisposing risk factors and recurrent and repetitive microtrauma in popliteal fossa (the patient is a professional runner). Our case suggests the need for further studies about real world incidence of GCA associated vaccination and COVID-19 infection. Currently, data is limited regarding this relationship. We continue to encourage COVID-19 vaccination, even in elderly patients because the benefits of vaccination far outweigh any theoretical risk of immune dysregulation following administration.
巨细胞动脉炎（GCA）是一种罕见的肉芽肿性血管炎，通常累及老年患者的中、大动脉。在当前的新冠疫情期间，GCA的发病率有所上升，且新冠病毒感染以其免疫失调而闻名。下肢受累并不常见，但可能威胁肢体，导致肢体丧失。
一名43岁男性出现右小腿和足部突发疼痛，伴有苍白和体温过低，并有缺血的客观证据。症状在他接种第一剂新冠mRNA疫苗几天后开始出现，且在接种疫苗20天后出现新冠无症状感染。他在感染新冠之前没有任何跛行迹象或肢体创伤史，身体状况良好。增强计算机断层扫描和磁共振成像（MRI）提示诊断为腘动脉囊性外膜病。我们通过后路手术，使用右大隐静脉移植物对受累的腘动脉进行了切除并置换。术后第四天，他出院了。组织病理学检查显示，在内膜和外膜有散在的壁内炎症浸润，由淋巴细胞和罕见的多核巨细胞组成，符合GCA的诊断。
我们的病例是首例报道的接种新冠mRNA疫苗及感染新冠病毒后孤立性腘动脉GCA病例。我们认为，对疫苗上调的免疫反应在这个具有易感风险因素且腘窝反复微创伤的患者（患者是一名职业跑步运动员）中触发了GCA。我们的病例表明需要进一步研究与接种疫苗及新冠病毒感染相关的GCA在现实世界中的发病率。目前，关于这种关系的数据有限。我们继续鼓励接种新冠疫苗，即使是老年患者，因为接种疫苗的益处远大于接种后免疫失调的任何理论风险。
