Giant Cell Arteritis after COVID-19 Vaccination with Long-Term Follow-Up: A Case Report and Review of the Literature
Abstract
:1. Introduction
2. Case Presentation
3. Discussion
- [clinical criteria]
- (1)
- morning stiffness in the shoulders/neck (+2)
- (2)
- sudden visual loss (+3)
- (3)
- jaw or tongue claudication (+2)
- (4)
- new temporal headache (+2)
- (5)
- scalp tenderness (+2)
- (6)
- abnormal examination of the temporal artery (+2)
- [test/imaging/biopsy criteria]
- (7)
- maximum ESR ≥50 mm/hour or maximum CRP ≥ 10 mg/L (+3)
- (8)
- positive temporal artery biopsy or halo sign on temporal artery ultrasound (+5)
- (9)
- bilateral axillary involvement (+2)
- (10)
- PET activity throughout the aorta (+2)
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Test Name | At the Time of Arrival | 27 Days after Treatment | Reference Range |
---|---|---|---|
White blood cells (μL) | 8300 | 8200 | 3300–8600 |
Red blood cells (104/μL) | 254 | 336 | 386–492 |
Hemoglobin (g/dL) | 7.6 | 10.4 | 11.6–14.8 |
Hematocrit (%) | 22.9 | 31.8 | 35.1–44.4 |
Platelets (104/μL) | 58.6 | 17.1 | 15.8–34.8 |
ESR 1 h (mm) | >140 | 5 | 3–5 |
D-dimer (μg/mL) | 1.7 | 1.4 | 0.0–1.0 |
C-reactive protein (mg/L) | 211 | 0.1 | 0.0–1.4 |
Aspartate aminotransferase (U/L) | 30 | 16 | 13–30 |
Alanine transaminase (U/L) | 40 | 23 | 7–23 |
Lactate dehydrogenase (U/L) | 137 | 200 | 124–222 |
Alkaline phosphatase (U/L) | 106 | 76 | 106–322 |
Gamma glutamyl transpeptidase (U/L) | 63 | 26 | 9–32 |
Blood urea nitrogen (mg/dL) | 11 | 18 | 8–20 |
Creatinine (mg/dL) | 0.7 | 0.76 | 0.46–0.79 |
Total bilirubin (mg/dL) | 0.6 | 0.9 | 0.4–1.5 |
Procalcitonin (ng/mL) | 0.12 | - | <0.05 |
50% hemolytic complement activity (CH50) (U/mL) | 63 | - | 30–46 |
Complement component 3 (C3) (mg/dL) | 156 | - | 73–138 |
Complement component 4 (C4) (mg/dL) | 37 | - | 11–31 |
IgA (mg/dL) | 275 | - | 93–393 |
IgG (mg/dL) | 1697 | - | 861–1747 |
IgM (mg/dL) | 55 | - | 50–269 |
IgG4 (mg/dL) | 91 | 11–121 | |
PR3-ANCA (U/mL) | <1.0 | - | <1.0 |
MPO-ANCA (U/mL) | <1.0 | - | <1.0 |
Antinuclear Antibodies | 1:80 | - | <40 |
Ferritin (ng/mL) | 507 | 370 * | <55 |
Soluble interleukin-2 receptor (U/mL) | 712 | -- | 157–474 |
Blood culture | Negative | - | Negative |
Polymerase chain reaction (PCR) for SARS-CoV-2 | Negative | - | Negative |
Reference | Sex, Age | Past Medical History | Symptoms | Type of Vaccine | Number of Vx | Time from Vx to Onset | Time from Onset to Dx | Mode of Dx | Result of Biopsy | LV-GCA or C-GCA | Arteritis Location | CRP (mg/L) | ESR (mm/h) | Treatment | Time to Improvement | Treatment Duration | Outcome |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Cadiou et al. [12] | F, 70 | PMR | Fatigue | Viral vector | 2 | 10 days | 3 weeks | PET | Not described | LV-GCA | A panaortic and supra-aortic vasculitis (PET) | 104 | - | PSL 40 mg | 1 month | More than 11 weeks | Discharge |
Sauret et al. [13] | M, 70 | Not described | Headache, hyperesthesia of the scalp | Viral vector | 1 | Few days | Not described | Biopsy | GCA | C-GCA | Temporal artery (PET, No large vessel vasculitis) | 14 | - | PSL 0.5 mg/kg | Following day | Not described | Discharge |
Xia et al. [14] | M, 68 | Chronic obstructive pulmonary disease | Right-sided temporal headache, blurred vision, bilateral jaw claudication | Viral vector | 2 | 3–5 days | 3 weeks | Biopsy | GCA | C-GCA | Temporal artery (Angiogram normal) | 29 | 4 | 1 g mPSL pulse, PSL 65 mg, TCZ 162 mg | PSL 65 mg only, blurred vision on opposite side after 3 months, improved after 3 months with TCZ | More than 6 months | Discharge |
Sardo et al. [15] | M, 78 | Melanoma, HTN Hepatitis B infection, | Headache, fatigue, jaw claudication, scotomas, pharyngalgia, dry cough | Viral vector | 2 | 1 day | 1 month | Biopsy | GCA | LV-GCA | Ascending aorta, aortic arch, descending aorta, iliac axes bilaterally and subclavian bilaterally (PET) | 84 | - | PSL 1 mg/kg TCZ | A few weeks | More than 8 months | Discharge |
Greb et al. [16] | M, 79 | HTN, hyperlipidemia, atrial fibrillation, hypothyroidism, prostate cancer, rectal cancer | Headache, transient blurry vision, fever, fatigue, myalgias | mRNA | 2 | 2 days | 1 month | Biopsy | GCA | C-GCA | Temporal artery | 272 | 97 | PSL 60 mg | 3 weeks | More than 6 weeks | Discharge |
Cadiou et al. [12] | F, 74 | Advanced ovarian cancer | Headache, jaw claudication | mRNA | 1 | 7 days | 5 weeks | Biopsy | GCA | C-GCA | Temporal artery | 190 | - | PSL 60 mg | 1 week | Not described | Discharge |
Gambichler et al. [17] | M, 82 | Not described | Headaches, jaw claudication, weight loss, bilateral temporoparietal skin necrosis, vision loss | mRNA | 2 | 10 days | 4 months | Biopsy | GCA | C-GCA | Temporal artery | 63 | - | Not described | Not described | Not described | Discharge (Complete vision loss before treatment) |
Mejren et al. [18] | F, 62 | Not described | Fatigue, weight loss, night sweat, nausea | mRNA | 1, 2 | 1–2 days | 7–8 weeks | PET | Not described | LV-GCA | The vertebral, common carotid, maxillary, axillary, subclavian, internal mammary, common iliac arteries, throughout the aorta (PET) | 98 | - | PSL 40 mg | 2 weeks | Not described | Discharge |
Anzola et al. [19] | F, 83 | Dyslipidemia, HTN | Disruptive cervical pain, headache, scalp tenderness | mRNA | 1 | 1 day | 3 weeks | PET | Normal | LV-GCA | Bilateral vertebral artery (PET) | 14 | 71 | Pulse steroids, methotrexate, medium-dose steroids | 3 months | More than 6 months | Discharge (Remission weekly methotrexate and low-dose steroids) |
Che et al. [20] | F, 87 | HTN | Visual loss, scalp tenderness, fever | mRNA | 1 | 1 day | 2 weeks | Biopsy | GCA | C-GCA | Temporal artery | 8 | 120 | Pulse steroids, PSL 60 mg | 4 months | More than 6 months | Discharge (Right eye complete vision loss, left eye blurred vision improved) |
Gilio et al. [21] | F, 63 | HTN | Fatigue, myalgias, low grade fevers, anorexia, headache, arthralgia, stiffness of upper arms, shoulders and neck | mRNA | 1 | 1 day | 1 month | PET | Not described | LV-GCA | Aortic arch, thoracic and abdominal aorta, carotid, subclavian arteries (PET) | 74 | 104 | PSL 50 mg | 4 weeks | Not described (tapering ongoing) | Discharge (Tapering ongoing) |
Ishizuka et al. [22] | M, 74 | HTN | Cough, left temporal headache | mRNA | 3 | 1 day | 2 months | PET | Not described | LV-GCA | Thoracic aorta, subclavian, axillary, brachial and temporal arteries (PET) | 63 | 79 | PSL 30 mg | Not described | Not described | Not described (Symptoms improved) |
Wakabayashi et al. [23] | M, 77 | Type 2 diabetes mellitus, Basedow’s disease, prostate cancer | Fatigue, headache, nodular swelling and tenderness of the bilateral temporal arteries | mRNA | 3 | 1 day | 3 months | Echography | Normal | C-GCA | Temporal artery (Echography) | 134 | 62 | 1 g mPSL pulse PSL 1 mg/kg TCZ 162 mg | 16 days | More than 45 days | Discharge (PSL 30 mg) |
Yoshimoto et al. (this case) | F, 69 | None | Headache, fever, abdominal pain, body weight loss | mRNA | 1 | 2 days | 38 days (5 weeks) | PET | GCA | LV-GCA | Ascending aorta, aortic arch, descending aorta, bilateral subclavian and iliac artery (PET) | 211 | 140 | 1g mPSL pulse PSL 50 mg TCZ 162 mg | 2 weeks | 2 years | Discharge (Remission with PSL 3 mg & TCZ) |
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Yoshimoto, K.; Kaneda, S.; Asada, M.; Taguchi, H.; Kawashima, H.; Yoneima, R.; Matsuoka, H.; Tsushima, E.; Ono, S.; Matsubara, M.; et al. Giant Cell Arteritis after COVID-19 Vaccination with Long-Term Follow-Up: A Case Report and Review of the Literature. Medicina 2023, 59, 2127. https://doi.org/10.3390/medicina59122127
Yoshimoto K, Kaneda S, Asada M, Taguchi H, Kawashima H, Yoneima R, Matsuoka H, Tsushima E, Ono S, Matsubara M, et al. Giant Cell Arteritis after COVID-19 Vaccination with Long-Term Follow-Up: A Case Report and Review of the Literature. Medicina. 2023; 59(12):2127. https://doi.org/10.3390/medicina59122127
Chicago/Turabian StyleYoshimoto, Kiyomi, Saori Kaneda, Moe Asada, Hiroyuki Taguchi, Hiromasa Kawashima, Ryo Yoneima, Hidetoshi Matsuoka, Emiko Tsushima, Shiro Ono, Masaki Matsubara, and et al. 2023. "Giant Cell Arteritis after COVID-19 Vaccination with Long-Term Follow-Up: A Case Report and Review of the Literature" Medicina 59, no. 12: 2127. https://doi.org/10.3390/medicina59122127