Case report: Acute exacerbation of interstitial pneumonia related to messenger RNA COVID-19 vaccination

Messenger RNA (mRNA) vaccines that protect against COVID-19 are widely used in many countries owing to their high efficacy and safety profiles. Recently, few severe adverse events, such as anaphylaxis and myocarditis, were reported in healthy individuals. The safety of mRNA COVID-19 vaccines has not been adequately studied in patients with interstitial lung disease. We report 2 cases of acute exacerbation of preexisting interstitial pneumonia associated with mRNA COVID-19 vaccination. In both cases, lung disease was stable before the vaccination. Initial responses to steroid therapy were unfavorable, and intravenous cyclophosphamide was administered in both cases. Both patients were diagnosed with vaccine related exacerbation of interstitial pneumonia based on laboratory results, radiologic features, and the observed clinical course, which lacked other causative events. We suggest that clinicians should note the possibility of acute exacerbation of pneumonia after mRNA COVID-19 vaccination and carefully monitor patients with interstitial lung disease. (C) 2022 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

Automated summary

This study reports two cases of acute exacerbation of preexisting interstitial pneumonia associated with mRNA COVID-19 vaccination. The lung disease was stable before vaccination, but initial steroid therapy showed unfavorable responses and further treatment was required. The study suggests that clinicians should be aware of the possibility of acute exacerbation of pneumonia in patients with interstitial lung disease after mRNA COVID-19 vaccination and monitor them closely.