tetano
Editor, Senior Moderator
Crit Care Explor
. 2021 Nov 5;3(11):e0578.
doi: 10.1097/CCE.0000000000000578. eCollection 2021 Nov.
Multisystem Inflammation and Organ Dysfunction After BNT162b2 Messenger RNA Coronavirus Disease 2019 Vaccination
Benjamin Kahn[SUP] 1 [/SUP], Sokratis A Apostolidis[SUP] 2 3 [/SUP], Vatsal Bhatt[SUP] 4 [/SUP], Allison R Greenplate[SUP] 3 5 6 [/SUP], Staci Kallish[SUP] 7 [/SUP], Anthony LaCava[SUP] 8 [/SUP], Alfredo Lucas[SUP] 1 [/SUP], Nuala J Meyer[SUP] 8 [/SUP], Dan Negoianu[SUP] 9 [/SUP], Alexis R Ogdie[SUP] 2 [/SUP], Michael G S Shashaty[SUP] 8 [/SUP], Patricia A Takach[SUP] 8 [/SUP], Leah Zuroff[SUP] 10 [/SUP], E John Wherry[SUP] 3 5 6 [/SUP], George L Anesi[SUP] 8 [/SUP]
Affiliations
Abstract
The U.S. Food and Drug Administration has to date granted approval or emergency use authorization to three vaccines against severe acute respiratory syndrome coronavirus 2 and coronavirus disease 2019. In clinical trials and real-use observational studies, the Pfizer-BioNTech BNT162b2 messenger RNA coronavirus disease 2019 vaccine, as well as the Moderna mRNA-1273 messenger RNA coronavirus disease 2019 vaccine, have demonstrated high efficacy and few adverse events.
Case summary: A 20-year-old male college student in good health developed tinnitus and hematuria shortly after vaccination and progressed swiftly to a syndrome of: systemic inflammation; acute kidney injury requiring hemodialysis; acute, bilateral, complete sensorineural hearing loss; radiographic evidence of acute multifocal ischemic strokes; pericardial effusion complicated by tamponade physiology requiring pericardial evacuation; pleural effusions requiring evacuation; and systemic capillary leak. An extensive clinical and research investigation, including cytokine analysis, whole blood cytometry by time of flight, and whole exome sequencing, did not reveal a definitive explanatory mechanism.
Conclusion: While the overall safety profile of the BNT162b2 coronavirus disease 2019 vaccine remains excellent for the general population, rare serious events have been reported. In this report, we describe a case of multisystem inflammation and organ dysfunction of unknown mechanism beginning shortly after administration of the first dose of BNT162b2 coronavirus disease 2019 vaccine in a previously healthy recipient.
Keywords: adverse event; coronavirus disease 2019; inflammation; multisystem organ dysfunction; vaccination.
. 2021 Nov 5;3(11):e0578.
doi: 10.1097/CCE.0000000000000578. eCollection 2021 Nov.
Multisystem Inflammation and Organ Dysfunction After BNT162b2 Messenger RNA Coronavirus Disease 2019 Vaccination
Benjamin Kahn[SUP] 1 [/SUP], Sokratis A Apostolidis[SUP] 2 3 [/SUP], Vatsal Bhatt[SUP] 4 [/SUP], Allison R Greenplate[SUP] 3 5 6 [/SUP], Staci Kallish[SUP] 7 [/SUP], Anthony LaCava[SUP] 8 [/SUP], Alfredo Lucas[SUP] 1 [/SUP], Nuala J Meyer[SUP] 8 [/SUP], Dan Negoianu[SUP] 9 [/SUP], Alexis R Ogdie[SUP] 2 [/SUP], Michael G S Shashaty[SUP] 8 [/SUP], Patricia A Takach[SUP] 8 [/SUP], Leah Zuroff[SUP] 10 [/SUP], E John Wherry[SUP] 3 5 6 [/SUP], George L Anesi[SUP] 8 [/SUP]
Affiliations
- PMID: 34765984
- PMCID: PMC8575416
- DOI: 10.1097/CCE.0000000000000578
Abstract
The U.S. Food and Drug Administration has to date granted approval or emergency use authorization to three vaccines against severe acute respiratory syndrome coronavirus 2 and coronavirus disease 2019. In clinical trials and real-use observational studies, the Pfizer-BioNTech BNT162b2 messenger RNA coronavirus disease 2019 vaccine, as well as the Moderna mRNA-1273 messenger RNA coronavirus disease 2019 vaccine, have demonstrated high efficacy and few adverse events.
Case summary: A 20-year-old male college student in good health developed tinnitus and hematuria shortly after vaccination and progressed swiftly to a syndrome of: systemic inflammation; acute kidney injury requiring hemodialysis; acute, bilateral, complete sensorineural hearing loss; radiographic evidence of acute multifocal ischemic strokes; pericardial effusion complicated by tamponade physiology requiring pericardial evacuation; pleural effusions requiring evacuation; and systemic capillary leak. An extensive clinical and research investigation, including cytokine analysis, whole blood cytometry by time of flight, and whole exome sequencing, did not reveal a definitive explanatory mechanism.
Conclusion: While the overall safety profile of the BNT162b2 coronavirus disease 2019 vaccine remains excellent for the general population, rare serious events have been reported. In this report, we describe a case of multisystem inflammation and organ dysfunction of unknown mechanism beginning shortly after administration of the first dose of BNT162b2 coronavirus disease 2019 vaccine in a previously healthy recipient.
Keywords: adverse event; coronavirus disease 2019; inflammation; multisystem organ dysfunction; vaccination.