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Case Reports
. 2021 Dec:1:1-3.
doi: 10.1016/j.clicom.2021.08.001. Epub 2021 Sep 27.

Pfizer-biontech COVID-19 RNA vaccination induces phosphatidylserine autoantibodies, cryoglobulinemia, and digital necrosis in a patient with pre-existing autoimmunity

Sandy Nasr  1 , Sara Khalil  1 , Bernard J Poiesz  1 , Katalin Banki  1 , Andras Perl  1
Affiliations
Case Reports

Pfizer-biontech COVID-19 RNA vaccination induces phosphatidylserine autoantibodies, cryoglobulinemia, and digital necrosis in a patient with pre-existing autoimmunity

Sandy Nasr et al. Clin Immunol Commun. 2021 Dec.

Abstract

We describe a 64-year-old Caucasian female with a history of Raynaud's disease, hand arthritis, photosensitivity, Sjogren's syndrome and leukocytoclastic vasculitis who presented with progressively worsening fingertip necrosis that began three days after receiving a first dose of Pfizer-BioNTech COVID-19 RNA vaccine. Our workup revealed cryoglobulinemia, hypocomplementemia, elevated antinuclear antibodies (ANA) and IgM antiphospholipid autoantibodies (aPL) directed against phosphatidylserine (aPL-PS), suggesting a diagnosis of systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). The patient failed to develop anti-spike IgG antibodies up to two months following vaccination. Disease progression was halted by plasmapheresis, anticoagulation, and immune suppression. We conclude that the vaccine RNA moiety may induce SLE manifesting in APS, cryoglobulinemia, hypocomplementemia, and digital necrosis.

Keywords: Antiphospholipid antibody; Antiphospholipid syndrome; Cryoglobulinemia; Digital necrosis; Pfizer–BioNTech COVID-19 RNA vaccine; Phosphatidylserine antibody; Systemic lupus erythematosus; Vasculitis.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1
Fig. 1
Induction of digital necrosis by Pfizer–BioNTech COVID-19 RNA vaccination. A, Digital necrosis and bilateral leg vasculitis upon presentation to the ED on 3/11/2021. B, Progressive demarcation of fingertip necrotic lesions upon follow-up office visit on 4/21/2021.
See this image and copyright information in PMC

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