Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Jan 10;15(1):e33620.
doi: 10.7759/cureus.33620. eCollection 2023 Jan.

Polyarteritis Nodosa Following mRNA-1273 COVID-19 Vaccination: Case Study and Review of Immunological Mechanisms

Bahadar S Srichawla  1
Affiliations
Case Reports

Polyarteritis Nodosa Following mRNA-1273 COVID-19 Vaccination: Case Study and Review of Immunological Mechanisms

Bahadar S Srichawla. Cureus. .

Abstract

Numerous post-vaccine complications have been reported secondary to the COVID-19 vaccine. Many of these complications are believed to be due to a hyperactive immune system. A 59-year-old woman developed diffuse abdominal pain two days after receiving the mRNA-1273 COVID-19 vaccine (Moderna). A computerized tomography (CT) angiogram of the abdomen and pelvis revealed the presence of numerous vascular irregularities in the celiac axis, bilateral renal arteries, and inferior mesenteric artery consistent with polyarteritis nodosa (PAN), a medium-vessel vasculitis. The patient was managed with intravenous methylprednisolone 500 mg daily for three days and was then placed on oral methotrexate (MTX) 12.5 mg daily for immunosuppressive maintenance treatment. Until now, a limited number of cases of polyarteritis nodosa secondary to the COVID-19 vaccine have been reported. Major mechanisms of post-vaccine autoimmunity are molecular mimicry and autoantibody production. Although rare adverse events from COVID-19 vaccination are possible, there remains an immense benefit to vaccination in preventing COVID-19-related morbidity and mortality.

Keywords: coronavirus disease 2019; covid 19; moderna covid-19 vaccine; moderna mrna adverse effects; mrna-1273 vaccine; pfizer-biontech covid-19 vaccine; pfizer-biontech covid-19 vaccine related adverse events; polyarteritis nodosa; sars-cov-2; severe acute respiratory syndrome coronavirus 2.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Initial computerized tomography (CT) angiography of the abdomen and pelvis
(A) Irregularity of the distal portion of the right renal artery with multifocal aneurysmal dilatation. (B) Slight narrowing at the proximal aspect of the splenic artery. (C) Irregularity and dilatation of the proximal aspect of the inferior mesenteric artery. (D) Heterogenous hypo-enhancement of the posterior aspect of the right kidney.
Figure 2
Figure 2. Repeat CT abdomen and pelvis angiography two months after discharge.
(A-C) Resolution of prior vascular irregularities of the left renal, splenic, and inferior mesenteric arteries. (D) Resolution of renal parenchymal hypo-enhancement.
Figure 3
Figure 3. Molecular mimicry hypothesis
This figure was created using BioRender [17]
See this image and copyright information in PMC

References

    1. What defines an efficacious COVID-19 vaccine? A review of the challenges assessing the clinical efficacy of vaccines against SARS-CoV-2. Hodgson SH, Mansatta K, Mallett G, Harris V, Emary KR, Pollard AJ. Lancet Infect Dis. 2021;21:0–35. - PMC - PubMed
    1. Acute transverse myelitis (ATM): clinical review of 43 patients with COVID-19-associated ATM and 3 post-vaccination ATM serious adverse events with the ChAdOx1 nCoV-19 vaccine (AZD1222) Román GC, Gracia F, Torres A, Palacios A, Gracia K, Harris D. Front Immunol. 2021;12:653786. - PMC - PubMed
    1. Clinical approach to diagnosis and therapy of polyarteritis nodosa. Hočevar A, Tomšič M, Perdan Pirkmajer K. Curr Rheumatol Rep. 2021;23:14. - PubMed
    1. Gastrointestinal involvement in polyarteritis nodosa. Ebert EC, Hagspiel KD, Nagar M, Schlesinger N. Clin Gastroenterol Hepatol. 2008;6:960–966. - PubMed
    1. Diagnosis and classification of polyarteritis nodosa. Hernández-Rodríguez J, Alba MA, Prieto-González S, Cid MC. J Autoimmun. 2014;48-49:84–89. - PubMed

Publication types

LinkOut - more resources