Main Author: Samy Zakout
Sharjah, United Arab Emirates
The new development or the exacerbation of an already existent autoimmune disease after COVID infection and/ or vaccine has been described in several occasions in the literature.
In this report, two cases are being discussed in order to shed light on this evolving aspect. In patient A, the occurrence of a potentially rare autoimmune disease seems to have followed a COVID infection, whereas in patient B, another stable and well-controlled autoimmune illness has become overly active and hard to treat after a COVID vaccine booster dose.
SRP-positive polymyositis is a rare form of the idiopathic inflammatory myositis group. It is also characterised by its unique myocardial muscle involvement as well as the necrotising and treatment-resistant myopathy.
A previously healthy 48-year-old male patient developed muscle weakness associated with some elevation of creatine kinase (CK) only one month after acquiring COVID infection. When he then experienced chest pain and further to his high troponin level, he had a coronary angiogram that ruled out any coronary event. His autoimmune profile later on confirmed positive SRP and Ro52 antibodies and his CK was significantly elevated at 12,000. He then received immunosuppression with high glucocorticoid doses and mycophenolate mofetil (MMF). When he relapsed after his initial improvement, he was considered for Rituximab therapy.
A 40-year-old female patient with a 5-year history of stable and controlled lupus nephritis developed acute nephrotic syndrome one week after the COVID vaccine booster dose. She used to be on MMF 1g daily without any glucocorticoids when no protein had been detected in her urine.
Straight after the vaccine, she developed peri-orbital and lower limb oedema and significant hair loss. When reviewed in the rheumatology clinic, her 24 hour-urinary protein exceeded 6g and her complement 3 was reduced. She had then received 3 pulses of intravenous methylprednisolone 500mg followed by daily oral prednisolone at 10mg in addition to increasing her MMF to 3g daily. As the patient was reluctant to increase her oral prednisolone and in the presence of her poor response to the those treatment measures, she received one cycle of Rituximab of a total of 2g over two weeks. Fortunately, her lupus responded very well to Rituximab in terms of protein-losing nephropathy and hair loss as early as one month after the infusion.
The above-mentioned two reports provide further evidence to the globally reported similar cases when a form of the immune system dysregulation seems to follow a COVID-related clinical event either in the form of the pertinent vaccine or the illness itself.
More case reports are still needed in order to add further support to this growing awareness regarding these pathological events that could follow both COVID infections and its vaccine. Patients would need to be kept informed when a clinical decision about the vaccine is to be made. As yet, the benefits of such a vaccine would probably outweigh the risks, but every single case ought to be addressed separately