Acute Exacerbation of Interstitial Lung Disease After SARS-CoV-2 Vaccination: A Case Series

Abstract

An acute exacerbation of interstitial lung disease (ILD) is an acute deterioration that can occur at any time and is associated with significant morbidity and mortality rates. We herein report three patients with ILD who experienced acute respiratory failure after SARS-CoV-2 messenger RNA vaccination. All the patients were male; the mean age was 77 years. They had a smoking history that ranged from 10 to 30 pack-years. Duration from the vaccination to the onset of respiratory failure was 1 day in two patients and 9 days in one patient. In an autopsied case, lung pathologic evidence indicated diffuse alveolar damage superimposed on usual interstitial pneumonia. In the other two cases, CT scans showed diffuse ground-glass opacities and subpleural reticulation, which suggests acute exacerbation of ILD. Two patients were treated successfully with high-dose methylprednisolone. Although benefits of vaccination outweigh the risks associated with uncommon adverse events, patients with chronic lung diseases should be observed carefully after SARS-CoV-2 vaccination.

Figure 1

A-C, High resolution CT scan findings of Case 1. High-resolution CT scan taken B, 1 month before the exacerbation showed subpleural reticulation and traction bronchiectasis A, that had not been observed 15 months before. On admission, C, high-resolution CT scan revealed diffuse ground-glass opacities superimposed on the preexisting interstitial changes.

Figure 2

A and B, Autopsy findings from Case 1. A, The lungs had subpleural dense fibrosis with alternating areas of normal lung suggest temporal heterogeneity of fibrosis. As shown in the inset, scattered fibroblastic foci were also observed, which was suggestive of usual interstitial pneumonia. B, The lung pathology report also showed diffuse alveolar damage that was characterized by infiltration of inflammatory cells and hyaline membranes with protein-rich edema fluid.

Figure 3

A-C, High-resolution CT scan findings from Case 2. A and B, High-resolution CT scan on admission show diffuse ground-glass opacities with subpleural reticulation and traction bronchiectasis. C, After high-dose steroid therapy, high-resolution CT scan on the day 27 from admission revealed resolution of ground-glass opacities; however, subpleural reticulation and traction bronchiectasis remained.

Figure 4

A and B, High-resolution CT scan findings from Case 3. A, High-resolution CT scan 4 months before the admission shows honeycombing with subpleural reticulation predominantly in the lung bases, which indicates a clinical diagnosis of idiopathic pulmonary fibrosis. B, On admission, his high-resolution CT scan showed wide-spread ground-glass opacity, which was superimposed on preexisting honeycombing and subpleural reticulation.