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:10.1097/CCE.0000000000000578

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

Affiliations

Benjamin Kahn, BA: 1 University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Sokratis A. Apostolidis, MD: 2 Division of Rheumatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Vatsal Bhatt, MD: 4 Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Allison R. Greenplate, PhD: 3 Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Staci Kallish, DO: 7 Division of Translational Medicine and Human Genetics, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Anthony LaCava, MD: 8 Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Alfredo Lucas, BA: 1 University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Nuala J. Meyer, MD, MS: 8 Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Dan Negoianu, MD: 9 Division of Renal Electrolyte and Hypertension, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Alexis R. Ogdie, MD, MSCE: 2 Division of Rheumatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Michael G. S. Shashaty, MD, MSCE: 8 Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Patricia A. Takach, MD: 8 Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Leah Zuroff, MD, MS: 10 Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
E. John Wherry, PhD: 3 Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
George L. Anesi, MD, MSCE, MBE: 8 Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

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.

Published in Critical Care Explorations

ISSN: 2639-8028 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://journals.lww.com/ccejournal/pages/default.aspx

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