gms | German Medical Science

Introduction: We here present a case series of four patients that got diagnosed with GCA in close timely association with vaccination against SARS-CoV-2. Of them, three were vaccinated with the mRNA-based BNT162b2 vaccine by BioNTech and one with the vector-based vaccine AZD1222 from AstraZeneca. We therefore analyzed the occurrence, and described the clinical course of patients with large vessel vasculitis (LVV) associated with SARS-CoV-2 vaccination.

Methods: Patients were diagnosed at the rheumatology and angiology department of the LMU hospital in Munich. Diagnostic tools included clinical examination, laboratory tests, color-duplex-ultrasound (CDUS). In one case Three-Dimensional High-Resolution Black-Blood Magnetic Resonance Imaging was used as an additional diagnostic tool.

Results: Of the patients, two were male and two female. Time of symptom onset ranged from 0.5–10 days as approximated by the patients (see Table 1 [Tab. 1]). No patient had a family history of rheumatic disease. Although the diagnosis of large vessel vasculitis could be made without doubt, the patients and the course of disease were rather unusual for a typical giant cell arteritis (GCA): One patient was of Asian and one of African descent while GCA is a rarity in these ethnicities [1], both patients also had an atypical pattern of involvement, mainly affecting the occipital arteries (see Figure [Fig. 1] and Figure 2 [Fig. 2]). One patient who suffered from acute ischemic opticus neuropathy secondary to GCA (A-AION) unusually regained his eyesight after glucocorticoid treatment was started.

Conclusion: Cases of autoimmune events such as GCA following vaccination with influenza, certain infections, as well as seasonal uprises of GCA-incidence rates have been previously documented [2], [3]. As surveillance of SARS-CoV-2 vaccine-associated events is extremely high, there might be a tendency to overestimate the correlation/association between vaccination and autoimmune events such as GCA. Therefore, further studies are needed to confirm a pathophysiological interlink. However, our case series shows that vasculitides may occur as consequence of a possible autoimmune event after vaccination against SARS-CoV-2.

Acknowledgments: This work was supported by the Verbundanträge “GAIN” (project 8, 01GM1910C) and “COVIM” (project AP8, 01KX2021), both by the Federal Ministry of Education and Research of Germany; and by the FöFoLe program of the medical faculty of the LMU Munich.

Author contribution: MCvS contributed by acquiring, analyzing and interpreting the data and by drafting the work. AS contributed by designing and revising the work and by analyzing and interpreting the data. MCvS contributed by acquiring data. HSK contributed by designing the work, analyzing and interpreting the data and by drafting and revising the work. All authors have approved the submitted version and have agreed to be personally accountable for the author’s own contributions.