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接种新冠疫苗后发生风湿性多肌痛的罕见病例。

Rare Cases of Polymyalgia Rheumatica After Receiving COVID-19 Vaccinations.

作者信息

Furr Todd, Garg Manisha

机构信息

Internal Medicine, Ascension Providence Hospital, Southfield, USA.

出版信息

Cureus. 2023 Apr 18;15(4):e37782. doi: 10.7759/cureus.37782. eCollection 2023 Apr.

Abstract

Polymyalgia rheumatica (PMR) is a systemic rheumatic inflammatory disease of adults presenting with symmetrical proximal muscle stiffness and pain predominantly involving the shoulders, neck, and pelvic girdle. The coronavirus disease of 2019 (COVID-19) presented as a pandemic causing worldwide morbidity and mortality in large numbers. Rapid scientific research expedited preventative vaccine development and has helped tremendously in cutting down severe illness, hospitalizations, and death from COVID-19, with the messenger ribonucleic acid (mRNA) vaccines outperforming the others. We present two cases that showcase the incidence of polymyalgia rheumatica after receiving COVID-19 vaccination. Patient 1 is a 69-year-old female who developed arm and thigh stiffness a week before the second dose while receiving her primary Moderna vaccine series. She had an elevated C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), so she was started on low-dose steroids, which were weaned down over a five-month period. Three weeks after receiving her Moderna booster, she had a recurrence of the classic polymyalgia rheumatica symptoms and elevated ESR. She responded to prednisone 15 mg with a successful taper over eight months. Patient 2 is a 74-year-old male who received his primary series and booster through Pfizer-BioNTech. Prior to the booster, he was treated for COVID-19 with monoclonal antibody therapy. He presented to the office with hip and shoulder pain and stiffness along with an elevated C-reactive protein. Consequently, he received 20 mg of prednisone but needed to increase his dose to 25 mg total to help with the control of his inflammation. The goal of this article is to prompt physicians about the possibility of PMR incidence after patients receive vaccinations for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). PMR can be debilitating to the quality of life of patients. Knowing this association allows for more timely and competent treatment. PMR following SARS-CoV-2 vaccinations is continuously being observed in the medical field. Increased knowledge may help prevent the recurrence with subsequent doses. Further studies on the follow-up of such cases and the effect on subsequent immunization would be helpful.

摘要

风湿性多肌痛(PMR)是一种成人系统性风湿性炎症性疾病,表现为对称性近端肌肉僵硬和疼痛,主要累及肩部、颈部和骨盆带。2019年冠状病毒病(COVID-19)作为一种大流行病出现,在全球范围内导致大量发病和死亡。快速的科学研究加速了预防性疫苗的开发,并在极大程度上有助于减少COVID-19导致的重症、住院和死亡,其中信使核糖核酸(mRNA)疫苗的表现优于其他疫苗。我们报告两例展示接种COVID-19疫苗后风湿性多肌痛发病率的病例。病例1是一名69岁女性,在接种首剂莫德纳疫苗系列的第二剂前一周出现手臂和大腿僵硬。她的C反应蛋白(CRP)和红细胞沉降率(ESR)升高,因此开始使用低剂量类固醇,在五个月的时间里逐渐减量。在接种莫德纳加强针三周后,她再次出现典型的风湿性多肌痛症状,ESR升高。她对15毫克泼尼松有反应,在八个月的时间里成功减量。病例2是一名74岁男性,通过辉瑞-生物科技公司接种了首剂疫苗系列和加强针。在接种加强针之前,他接受了单克隆抗体治疗以治疗COVID-19。他因髋部和肩部疼痛及僵硬并伴有C反应蛋白升高前来就诊。因此,他接受了20毫克泼尼松治疗,但需要将剂量增至总共25毫克以帮助控制炎症。本文的目的是提醒医生注意患者接种严重急性呼吸综合征冠状病毒2(SARS-CoV-2)疫苗后发生PMR的可能性。PMR会使患者的生活质量下降。了解这种关联有助于更及时、更有效地进行治疗。在医学领域,SARS-CoV-2疫苗接种后发生PMR的情况一直在观察中。增加这方面的知识可能有助于预防后续剂量接种时疾病复发。对此类病例进行进一步随访研究以及对后续免疫的影响将是有益的。

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