Evidence is accumulating that not only SARS-CoV-2 infections but also
anti-SARS-CoV-2 vaccinations can be complicated by long-term side effects (long
post-COVID-vaccination syndrome (LPCVS)). We here report a patient with LPCVS
after the second dose of an mRNA-based anti-SARS-CoV-2 vaccine. The patient is a
45yo female, who developed headache, impaired concentration, vertigo, insomnia,
fatigue, exhaustibility, palpitations occurring spontaneously or during
exercise, unstable blood pressure, and loss of appetite with bloating
immediately after the second dose of an mRNA-based anti-SARS-CoV-2 vaccine.
Except for vertigo all other manifestations were previously unknown to the index
patient. Extensive work-up by means of instrumental investigations did not
reveal a plausible cause for her complaints. Depression was excluded as cause of
her complaints. Though improved, symptoms were still present at the 6-months
follow-up. It is concluded that anti-SARS-CoV-2 vaccinations can be followed by
long-term compromise, which is challenging to substantiate but needs to be taken
serious as affected patients can be severely compromised and unable to regain
their pre-vaccination status. Whether LPCVS more frequently occurs in patients
with comorbidities remains unknown but there are indications that certain
pre-morbid conditions favour its development.
SARS-CoV-2 vaccination, adverse reaction, side effect, stroke, COVID-19
From infections with SARS-CoV-2 it is known that the disease course may not only
extend over an acute phase (1-4 weeks) but also over a subacute phase (5-12
weeks), and even a chronic phase (>12 weeks) [1]. The chronic phase is also
known as post-COVID-syndrome and the subacute phase and the chronic phase are
summarised under the term “long-COVID” syndrome [1]. From SARS-CoV-2
vaccinations it is known that they may be complicated by several adverse
reactions, which can be mild, moderate, or severe [2]. There is now increasing
evidence that such complications can last >4 weeks and thus can be classified
as subacute respectively chronic adverse reactions. We here report a patient
with a myriad of long-term adverse reactions to the second dose of a SARS-CoV-2
vaccine in more than a single organ (long post-COVID-vaccination syndrome
(LPCVS)).
The patient is a 45yo Caucasian female, height 165cm, weight 56kg, who developed
chills and fever up to 39°C immediately after the second dose of an
mRNA-based SARS-CoV-2 vaccine (Moderna) in July 2021. These manifestations
resolved spontaneously within a few hours. Since the vaccination she
additionally developed headache, impaired concentration, vertigo, insomnia,
fatigue and exhaustibility, palpitations occurring spontaneously or during
exercise, and unstable blood pressure values, and loss of appetite with
bloating. Headache was previously unknown to the patient, projected to the right
frontal area, took an undulating course, and began to improve five months after
vaccination. Impaired concentration was described as brain fog or as being drunk
and did not improve earlier than four months after onset but was still present
at the 6m follow-up. She described vertigo as drowsiness which lasted for four
months and began to improve thereafter. Loss of appetite was still present at
the 6m follow-up and resulted in a weight loss of 6kg. Insomnia did not improve
before three months after onset but was still present at the 6m follow-up.
Fatigue and exhaustion persisted for four months and improved thereafter.
Palpitations and unstable blood pressure values partially resolved four months
after the vaccination but was still present at the 6m follow-up.
Work-up for loss of appetite and bloating on an emergency ward revealed an uterus
myomatosus but was otherwise normal. One day after the vaccination she
complained about dyspnoea. Routine work-up for dyspnoea at an emergency ward on
the same day was non-informative. One and a half months after the vaccination
she experienced an undulating bulb pressure over the right bulb and blurred
vision on the right eye which persisted for three months to decrease thereafter.
At the same time she experienced ear pressure bilaterally which persists until
today.
Her pre-vaccination history was positive for vertigo since age 21y, smoking,
multiple allergies (penicillin, iodine-containing contrast medium, orchad
grass), and allergic asthma. She had not experienced any side effects after the
first jab of the same vaccine. Her history was negative for any type of
headache. Her family history was positive for lung cancer (mother, father).
Clinical neurological exam 6 months after vaccination revealed sore neck muscles
exclusively. She denied any severe conflicts with her husband or tensions in her
job as a stewardess. Depression was excluded upon her previous history,
extensive exploration, and only 2 points on the HDRS17 depression
scale.
Work-up for the patient’s complaints included investigations such as blood
tests, cardiologic exam (ECG, 24h-ECG, 24h blood pressure monitoring,
echocardiography, stress test, spiral CT of lungs), oto-laryngological exam,
neurological investigations (carotid ultrasound, cerebral MRI), ultrasound of
the collum, swallowing act, thyroid ultrasound, and mammography, which were all
non-informative. Only the abdominal MRI revealed a cyst/hemangioma in segment 7
of the liver, and a small cyst in the left kidney. Ophthalmologic investigations
revealed astigmatism, myopia, presbyopia, fusion weakness and lack of
convergence, and a bulb pressure of 19 on the right side. X-ray of the cervical
spine revealed mild spondylosis and kyphosis. MRI of the orbita revealed an
empty sella. There was mild hypercholesterolemia. She benefited from
physiotherapy, tizanidine, and analgesics on demand.
The patient is interesting for multifocal LPCVS. LPCVS is not well defined but
patients report similar complaints as in long-COVID syndrome. These include
fatigue, post-exertional malaise, headache, dizziness, altered mental state,
disorientation, anosmia, myalgia, exertional dyspnoea, or dysgeusia [3].
Clinical neurologic examination and instrumental investigations are usually
non-informative, as in the index patient. The type and degree of clinical
manifestations of LPCVS may depend on the frequency and type of comorbidities
[4]. Some of the manifestations of LPCVS can be attributed to immune
thrombocytopenia, hypercoagulability, and the immune response triggered by the
vaccination [5]. Another pathophysiological factor that could explain the
syndrome could be the decline of titers of neutralising antibodies after
vaccination [6,7]. There are also indications that previous immunosuppression
may favour the development of side effects from anti-SARS-CoV-2 vaccinations
[8]. Which of these suspected pathophysiologic mechanisms was relevant for the
index patient remains speculative but the clinical presentation suggested that
she could suffer from a hereditary metabolic disease. Arguments in favour for
such a disorder are the short stature, the pituitary adenoma, the liver and
renal cysts, the ophthalmologic abnormalities, and the history of malignancies
in her mother.
In conclusion, this case shows that anti-SARS-CoV-2 vaccinations can be followed
by long-term compromise, which is challenging to substantiate but needs to be
taken serious as affected patients can be severely handicapped and unable to
attend and regain their pre-vaccination abilities, positions and tasks. Whether
LPCVS more frequently occurs in patients with comorbidities remains unknown but
there are indications that certain pre-morbid conditions favour its development.
Funding sources: No funding was received
Conflicts of interest: None
Acknowledgement: None
Ethics approval: Was in accordance with ethical guidelines. The
study was approved by the institutional review board
Consent to participate: Was obtained from the patient
Consent for publication: Was obtained from the patient
Availability of data: All data are available from the
corresponding author
Code availability: Not applicable
Author contribution: JF: design, literature search, discussion,
first draft, critical comments, final approval,
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