Critical Care Explorations (Nov 2021)

Multisystem Inflammation and Organ Dysfunction After BNT162b2 Messenger RNA Coronavirus Disease 2019 Vaccination

  • Benjamin Kahn, BA,
  • Sokratis A. Apostolidis, MD,
  • Vatsal Bhatt, MD,
  • Allison R. Greenplate, PhD,
  • Staci Kallish, DO,
  • Anthony LaCava, MD,
  • Alfredo Lucas, BA,
  • Nuala J. Meyer, MD, MS,
  • Dan Negoianu, MD,
  • Alexis R. Ogdie, MD, MSCE,
  • Michael G. S. Shashaty, MD, MSCE,
  • Patricia A. Takach, MD,
  • Leah Zuroff, MD, MS,
  • E. John Wherry, PhD,
  • George L. Anesi, MD, MSCE, MBE

DOI
https://doi.org/10.1097/CCE.0000000000000578
Journal volume & issue
Vol. 3, no. 11
p. e0578

Abstract

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BACKGROUND:. 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.