Department of General Medicine, Nara Medical University Hospital, Kashihara 634-8522, Nara, Japan.
Department of General Medicine, Uda City Hospital, Uda 633-0298, Nara, Japan.
Medicina (Kaunas). 2023 Dec 6;59(12):2127. doi: 10.3390/medicina59122127.
Giant cell arteritis (GCA) is a chronic vasculitis that primarily affects the elderly, and can cause visual impairment, requiring prompt diagnosis and treatment. The global impact of the coronavirus disease 2019 (COVID-19) pandemic has been substantial. Although vaccination programs have been a key defense strategy, concerns have arisen regarding post-vaccination immune-mediated disorders and related risks. We present a case of GCA after COVID-19 vaccination with 2 years of follow-up. A 69-year-old woman experienced fever, headaches, and local muscle pain two days after receiving the COVID-19 vaccine. Elevated inflammatory markers were observed, and positron emission tomography (PET) revealed abnormal uptake in the major arteries, including the aorta and subclavian and iliac arteries. Temporal artery biopsy confirmed the diagnosis of GCA. Treatment consisted of pulse therapy with methylprednisolone, followed by prednisolone (PSL) and tocilizumab. Immediately after the initiation of treatment, the fever and headaches disappeared, and the inflammation markers normalized. The PSL dosage was gradually reduced, and one year later, a PET scan showed that the inflammation had resolved. After two years, the PSL dosage was reduced to 3 mg. Fourteen reported cases of GCA after COVID-19 vaccination was reviewed to reveal a diverse clinical picture and treatment response. The time from onset of symptoms to GCA diagnosis varied from two weeks to four months, highlighting the challenge of early detection. The effectiveness of treatment varied, but was generally effective similarly to that of conventional GCA. This report emphasizes the need for clinical vigilance and encourages further data collection in post-vaccination GCA cases.
巨细胞动脉炎(GCA)是一种主要影响老年人的慢性血管炎,可导致视力损害,需要及时诊断和治疗。2019 年冠状病毒病(COVID-19)大流行的全球影响是巨大的。尽管疫苗接种计划是一项关键的防御策略,但人们对疫苗接种后的免疫介导性疾病及其相关风险表示担忧。我们报告了一例 COVID-19 疫苗接种后 2 年随访的 GCA 病例。一名 69 岁女性在接种 COVID-19 疫苗后两天出现发热、头痛和局部肌肉疼痛。观察到炎症标志物升高,正电子发射断层扫描(PET)显示大动脉异常摄取,包括主动脉、锁骨下动脉和髂动脉。颞动脉活检证实了 GCA 的诊断。治疗包括甲基强的松龙脉冲治疗,随后是泼尼松龙(PSL)和托珠单抗。治疗开始后立即,发热和头痛消失,炎症标志物恢复正常。PSL 剂量逐渐减少,一年后 PET 扫描显示炎症已消退。两年后,PSL 剂量减少至 3mg。回顾了 14 例 COVID-19 疫苗接种后 GCA 的报道病例,以揭示多样化的临床表现和治疗反应。从症状出现到 GCA 诊断的时间从两周到四个月不等,突出了早期发现的挑战。治疗效果不一,但总体上与传统 GCA 相似。本报告强调了临床警惕的必要性,并鼓励进一步收集疫苗接种后 GCA 病例的数据。