Department of Internal Medicine, Al-Khor Hospital, Hamad Medical Corporation, Doha, Qatar.
Department of Nephrology, Al-Khor Hospital, Hamad Medical Corporation, Doha, Qatar.
Mod Rheumatol Case Rep. 2023 Dec 29;8(1):153-158. doi: 10.1093/mrcr/rxad043.
Eosinophilic granulomatosis with polyangiitis (EGPA) is a complex multifactorial disease that results in multisystemic inflammation of the small- and medium-sized arteries. The exact pathogenesis of this syndrome is poorly understood, but it is postulated to result from a combination of eosinophilic dysfunction, genetic predisposition, and the development of autoantibodies after exposure to an unknown stimulus. We describe a case of new-onset EGPA following the third dose of the Pfizer-BioNTech mRNA vaccine in an infection-naive middle-aged man with a background history of allergic respiratory symptoms. The patient developed acute onset of mononeuritis multiplex, pauci-immune glomerulonephritis, and leucocytoclastic vasculitis 10 days after receiving the booster dose. His laboratory markers including eosinophil count, antineutrophil cytoplasmic antibodies, and renal function tests improved markedly after the initiation of pulse steroid therapy and rituximab infusion. However, his peripheral muscle weakness and neuropathic pain did not respond to the initial therapy but improved later with intravenous cyclophosphamide and intravenous immunoglobulin. To the best of our knowledge, this is the fourth case report of post-coronavirus disease 2019 vaccination precipitation of EGPA. All reported cases including our report were in patients with previous allergic manifestations who received mRNA-based coronavirus disease 2019 vaccines, and all the patients developed mononeuritis multiplex at presentation. Despite the few reported cases of post-vaccination autoimmune phenomena, the temporal association between vaccination administration and disease onset does not indicate causality, given the mass vaccination programmes employed. However, the novel use of the mRNA platform in vaccine delivery necessitates vigilant monitoring by the scientific committee.
嗜酸性肉芽肿性多血管炎（EGPA）是一种复杂的多因素疾病，导致小动脉和中等大小动脉的多系统炎症。这种综合征的确切发病机制尚不清楚，但据推测是由于嗜酸性粒细胞功能障碍、遗传易感性以及在接触未知刺激后产生自身抗体的共同作用所致。我们描述了一名感染史阴性的中年男子在接种辉瑞-生物科技公司 mRNA 疫苗第三剂后新发 EGPA 的病例，该男子有过敏呼吸道症状病史。在接受加强剂量后 10 天，患者出现急性多发性单神经炎、寡免疫性肾小球肾炎和白细胞碎裂性血管炎。他的实验室标志物，包括嗜酸性粒细胞计数、抗中性粒细胞胞浆抗体和肾功能检查，在开始脉冲类固醇治疗和利妥昔单抗输注后显著改善。然而，他的周围肌肉无力和神经痛对初始治疗没有反应，但后来用静脉环磷酰胺和静脉注射免疫球蛋白治疗后有所改善。据我们所知，这是第四例新冠肺炎疫苗接种后 EGPA 发病的病例报告。所有报告的病例，包括我们的报告，都发生在有既往过敏表现的患者中，他们接受了基于 mRNA 的新冠肺炎疫苗，所有患者在发病时都出现了多发性单神经炎。尽管有少数新冠肺炎疫苗接种后自身免疫现象的报道，但鉴于大规模疫苗接种计划的实施，接种疫苗与疾病发病之间的时间关联并不表明存在因果关系。然而，mRNA 平台在疫苗输送中的新应用需要科学委员会的警惕监测。
