Severe multisystem inflammatory response to COVID-19 vaccination

Document Type

Conference Proceeding

Publication Date

1-1-2022

Publication Title

Crit Care Med

Abstract

INTRODUCTION: In midst of the ongoing coronavirus disease 2019 (COVID-19) surges, immunization remains the primary hope to end this pandemic. Most side effects from vaccinations are mild to moderate in severity. Herein, we describe a critical case of an overwhelming multisystem inflammatory response in a healthy individual after COVID-19 vaccination. DESCRIPTION: The patient is a 39-year-old male with past medical history of two previous COVID-19 infections. Six days after receiving his COVID-19 vaccine, he started experiencing body aches, fatigue, diarrhea, fever, and shortness of breath. Upon presentation, he was hypoxic, febrile, tachycardic and hypotensive. His work up was significant for leukocytosis, lymphopenia, acute kidney injury, transaminitis, lactic acidosis and bilateral ground glass opacities on chest computed tomography. He was treated for presumed septic shock and hypoxic respiratory failure requiring mechanical ventilation. COVID-19 spike protein IgM/IgG antibodies were reactive but COVID-19 polymerase chain reaction (PCR) was negative. Ferritin level increased from 1400 ng/ml on admission to over 100,000 ng/ml on his second day of hospitalization. An extensive infectious, rheumatologic/autoimmune and malignancy workup was nonrevealing. Epstein-Barr Virus panel was positive at low titers which was thought to be a reactivation of infection secondary to immunocompromised status. Patient was noted to have splenomegaly, elevated triglycerides level to 451 mg/ dl, and elevated CD 25 level to 5925 μl/ml. Bone marrow biopsy was negative for malignant cells and hemophagocytes but positive for hemophagocytic macrophages with CD 163 immuno-stain which have propensity for hemophagocytosis. He was started on dexamethasone acetate (10 mg/m2) and etoposide as part of the hemophagocytic lymphohistiocytosis (HLH)-94 treatment protocol. The patient's acute inflammatory state resolved. One month after his acute illness, he remains on vent support being treated for neutropenic fever. DISCUSSION: This patient's overwhelming inflammatory response was attributed to COVID-19 vaccination after excluding other etiologies. Whether it were secondary HLH or multisystem inflammatory response to the vaccine, it is crucial to shed light on a rare but potentially fatal complication for which early diagnosis and treatment is key.

Volume

50

Issue

1 SUPPL

First Page

74

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