FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W4280494007> ?p ?o ?g. }

• W4280494007 endingPage "111" @default.
• W4280494007 startingPage "108" @default.
• W4280494007 abstract "IntroductionReactive arthritis (RA) is a rare disease that is characterized by a triad of urethritis, conjunctivitis, and arthritis, typically secondary to an extraarticular infection of the genitourinary or gastrointestinal tract.1Wu I.B. Schwartz R.A. Reiter's syndrome: the classic triad and more.J Am Acad Dermatol. 2008; 59: 113-121https://doi.org/10.1016/j.jaad.2008.02.047Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar There is often significant variation in clinical features, and patients may present with mucocutaneous findings, such as oral lesions, circinate balanitis, keratoderma blenorrhagicum, and nail dystrophy.1Wu I.B. Schwartz R.A. Reiter's syndrome: the classic triad and more.J Am Acad Dermatol. 2008; 59: 113-121https://doi.org/10.1016/j.jaad.2008.02.047Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar Human leukocyte antigen (HLA) B27 positivity is strongly associated with this condition. Herein, we present a case of RA favored to be triggered by the Pfizer-BioNTech COVID-19 messenger RNA (mRNA) vaccine, BNT162b2.Case reportA 49-year-old previously healthy man presented with progressively worsening skin lesions and arthritis. Roughly 1 week after receiving the first dose of the BNT162b2 vaccine, he developed a painful rash and swelling of the right foot, with progression of the rash to the left foot and penis. He did not have any preceding genitourinary or gastrointestinal symptoms. His primary care provider diagnosed a bacterial infection and prescribed a 2-week course of doxycycline 100 mg twice daily. He then received a 10-day course of prednisone 20 mg daily for joint pains. Over the next 2 weeks, he developed worsening arthritis of the shoulders, hands, and feet. At this time, he received prescriptions for gabapentin 600 mg and nifedipine 30 mg once daily for a presumed diagnosis of chilblains. The patient’s cutaneous and systemic symptoms persisted, and he experienced an unintentional weight loss of approximately 20 pounds.The patient presented to our emergency department approximately 2 months after the onset of his rash. Physical examination revealed pink papulopustules and keratoderma on the plantar aspects of the feet (Fig 1, A and B), extensive onycholysis, nail thickening, and subungual debris of the toenails (Fig 1, C); tender edema of the right foot and joints of the right hand (Fig 1, D and E), and a scaly erythematous plaque on the penis (Fig 1, F). Laboratory workup showed an elevated erythrocyte sedimentation rate and an elevated level of C-reactive protein. Blood and urine cultures were negative. HLA-B27 testing by flow cytometry was indeterminate. Further HLA-B27 genotyping was not performed; a definitive result was therefore not obtained. Additionally, the patient tested negative for syphilis, HIV, chlamydia, and gonorrhea.A punch biopsy of a pustule on the left foot showed psoriasiform epidermal hyperplasia, loss of the granular cell layer, neutrophilic infiltration of the epidermis, and entrapment of neutrophils in the stratum corneum; findings typical of a psoriasiform diathesis (Fig 2, A and B). Small-vessel vasculitis of the dermal papillary microvasculature was also observed. Additional immunologic stains revealed vascular deposits of complement factors C4d and C5b-9, representing classical complement pathway activation as seen in an Arthus type III immune complex reaction (Fig 2, C and D). Human-manufactured spike glycoprotein was identified within reticular dermal microvessels (Fig 3). These pathologic findings led to a diagnosis of keratoderma blenorrhagicum in the setting of RA triggered by the BNT162b2 vaccine.Fig 2Histopathology of lesion tissue. A and B, Histopathologic image of a lesion specimen showed irregular psoriasiform epidermal hyperplasia, parakeratotic scale, and an absent granular cell layer, in addition to extensive neutrophilic infiltration of the stratum corneum. Inflammatory changes were also noted within the dermis (A and B, hematoxylin-eosin stain; original magnification: A, ×100; B, ×400). C, C4d stain revealed extensive highlighting of the microvessels, indicative of classic complement pathway activation triggered by immune complex deposition (C4d stain; original magnification: ×400). D, C5b-9 stain demonstrated a positive reaction in a granular array within microvessels. The endpoint of classic complement pathway activation is the formation of C5b-9 (C5b-9 stain; original magnification: ×400).View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig 3SARS-CoV-2 (COVID-19) Spike S1 Subunit Antibody. The yellow arrow points to human-manufactured spike glycoprotein localized to microvessels of the reticular dermis. In RA, immune complexes (in this case spike glycoprotein complexed to host-manufactured antibody) localize to the superficial microvessels of the skin. In this patient, since spike glycoprotein was already bound by host-manufactured antibody in the papillary dermis, the spike protein was not detected in the papillary dermal vasculature (red-chromagen stain; original magnification: ×400). Reproduced with permission from Gerard Nuovo, MD, Columbus, OH.View Large Image Figure ViewerDownload Hi-res image Download (PPT)The patient experienced symptomatic improvement after 2 days of intravenous methylprednisolone 32 mg. He was discharged on oral prednisone and ibuprofen. He follows with rheumatology and continues to experience improvement with weekly methotrexate.DiscussionAdverse cutaneous reactions to COVID-19 mRNA vaccination have been well-documented in recent literature.2McMahon D.E. Amerson E. Rosenbach M. et al.Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: a registry-based study of 414 cases.J Am Acad Dermatol. 2021; 85: 46-55https://doi.org/10.1016/j.jaad.2021.03.092Abstract Full Text Full Text PDF PubMed Scopus (388) Google Scholar,3Magro C. Crowson A.N. Franks L. Schaffer P.R. Whelan P. Nuovo G. The histologic and molecular correlates of COVID-19 vaccine-induced changes in the skin.Clin Dermatol. 2021; 39: 966-984https://doi.org/10.1016/j.clindermatol.2021.07.011Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar Cutaneous morphologies purportedly vary, ranging from eczematous and psoriasiform rashes to vasculitic and bullous eruptions.2McMahon D.E. Amerson E. Rosenbach M. et al.Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: a registry-based study of 414 cases.J Am Acad Dermatol. 2021; 85: 46-55https://doi.org/10.1016/j.jaad.2021.03.092Abstract Full Text Full Text PDF PubMed Scopus (388) Google Scholar, 3Magro C. Crowson A.N. Franks L. Schaffer P.R. Whelan P. Nuovo G. The histologic and molecular correlates of COVID-19 vaccine-induced changes in the skin.Clin Dermatol. 2021; 39: 966-984https://doi.org/10.1016/j.clindermatol.2021.07.011Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar, 4Larson V. Seidenberg R. Caplan A. Brinster N.K. Meehan S.A. Kim R.H. Clinical and histopathological spectrum of delayed adverse cutaneous reactions following COVID-19 vaccination.J Cutan Pathol. 2022; 49: 34-41https://doi.org/10.1111/cup.14104Crossref PubMed Scopus (38) Google Scholar Cases of acute, new-onset arthritis following the COVID-19 vaccine have also been reported,5Unal Enginar A. Arthritis following COVID-19 vaccination: report of two cases.Int Immunopharmacol. 2021; 101: 108256https://doi.org/10.1016/j.intimp.2021.108256Crossref PubMed Scopus (7) Google Scholar,6Türk S.M. Öztürk Z. Karataş D. Gönüllü E. Inactivated COVID-19 vaccine can induce reactive polyarthritis in older patients: report of two cases.Georgian Med News. 2021; : 100-102PubMed Google Scholar as have flares of rheumatoid arthritis in patients with previously well-controlled disease.7Terracina K.A. Tan F.K. Flare of rheumatoid arthritis after COVID-19 vaccination.Lancet Rheumatol. 2021; 3: e469-e470https://doi.org/10.1016/S2665-9913(21)00108-9Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar Given the temporal onset of our patient’s symptoms and the unrevealing infectious and autoimmune workup, RA triggered by the COVID-19 vaccine was most favored in this case.RA has been described as a form of arthritis in which a type III immune complex-mediated reaction results from an antigenic stimulus. Typically, this syndrome occurs within 4 weeks of infection caused by species of Chlamydia, Salmonella, Shigella, Yersinia, or Campylobacter.1Wu I.B. Schwartz R.A. Reiter's syndrome: the classic triad and more.J Am Acad Dermatol. 2008; 59: 113-121https://doi.org/10.1016/j.jaad.2008.02.047Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar,8Magro C.M. Crowson A.N. Peeling R. Vasculitis as the basis of cutaneous lesions in Reiter's disease.Hum Pathol. 1995; 26: 633-638https://doi.org/10.1016/0046-8177(95)90168-xCrossref PubMed Google Scholar In the present case, the histologic findings of a psoriasiform tissue reaction accompanied by leukocytoclastic vasculitis were consistent with a diagnosis of keratoderma blenorrhagicum—the characteristic cutaneous manifestation of RA.8Magro C.M. Crowson A.N. Peeling R. Vasculitis as the basis of cutaneous lesions in Reiter's disease.Hum Pathol. 1995; 26: 633-638https://doi.org/10.1016/0046-8177(95)90168-xCrossref PubMed Google Scholar The extensive complement deposition in the microvasculature also highlighted the role of complement pathway activation in the pathogenesis of this condition. Immune complex-mediated reactions have been described following infection with and vaccination against COVID-19,9Mücke V.T. Knop V. Mücke M.M. Ochsendorf F. Zeuzem S. First description of immune complex vasculitis after COVID-19 vaccination with BNT162b2: a case report.BMC Infect Dis. 2021; 21: 958https://doi.org/10.1186/s12879-021-06655-xCrossref PubMed Scopus (16) Google Scholar and this case further illustrates the role of complement in these circumstances.The pathogenesis of hypersensitivity reactions following COVID-19 mRNA vaccination has not been well established. The BNT162b2 vaccine delivers mRNA that encodes the SARS-CoV-2 spike protein encapsulated in a lipid particle.4Larson V. Seidenberg R. Caplan A. Brinster N.K. Meehan S.A. Kim R.H. Clinical and histopathological spectrum of delayed adverse cutaneous reactions following COVID-19 vaccination.J Cutan Pathol. 2022; 49: 34-41https://doi.org/10.1111/cup.14104Crossref PubMed Scopus (38) Google Scholar It is therefore possible that this spike glycoprotein, which is produced by myocytes upon vaccination, may act as an antigenic stimulus. In our case, spike glycoprotein was indeed identified in the deep cutaneous vessels (Fig 3). Another potential trigger is the polyethylene glycol vaccine additive, a polymer that is used to stabilize the lipid nanoparticle formulation. It has been suggested that this polymer, which is known to cause type I hypersensitivity reactions, may also cause delayed antibody-mediated responses.3Magro C. Crowson A.N. Franks L. Schaffer P.R. Whelan P. Nuovo G. The histologic and molecular correlates of COVID-19 vaccine-induced changes in the skin.Clin Dermatol. 2021; 39: 966-984https://doi.org/10.1016/j.clindermatol.2021.07.011Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar,4Larson V. Seidenberg R. Caplan A. Brinster N.K. Meehan S.A. Kim R.H. Clinical and histopathological spectrum of delayed adverse cutaneous reactions following COVID-19 vaccination.J Cutan Pathol. 2022; 49: 34-41https://doi.org/10.1111/cup.14104Crossref PubMed Scopus (38) Google Scholar A third possibility is that the vaccine may unmask a hypersensitivity reaction to an unidentified trigger, such as an asymptomatic infection. Though we cannot conclusively determine whether there was a causal relationship between the COVID-19 mRNA vaccine and the development of RA in our patient, further investigation of rare cases, such as this one, will ideally enhance our understanding of immune-mediated reactions to COVID-19 vaccination. IntroductionReactive arthritis (RA) is a rare disease that is characterized by a triad of urethritis, conjunctivitis, and arthritis, typically secondary to an extraarticular infection of the genitourinary or gastrointestinal tract.1Wu I.B. Schwartz R.A. Reiter's syndrome: the classic triad and more.J Am Acad Dermatol. 2008; 59: 113-121https://doi.org/10.1016/j.jaad.2008.02.047Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar There is often significant variation in clinical features, and patients may present with mucocutaneous findings, such as oral lesions, circinate balanitis, keratoderma blenorrhagicum, and nail dystrophy.1Wu I.B. Schwartz R.A. Reiter's syndrome: the classic triad and more.J Am Acad Dermatol. 2008; 59: 113-121https://doi.org/10.1016/j.jaad.2008.02.047Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar Human leukocyte antigen (HLA) B27 positivity is strongly associated with this condition. Herein, we present a case of RA favored to be triggered by the Pfizer-BioNTech COVID-19 messenger RNA (mRNA) vaccine, BNT162b2." @default.
• W4280494007 created "2022-05-22" @default.
• W4280494007 creator A5064411755 @default.
• W4280494007 creator A5076263419 @default.
• W4280494007 creator A5086169812 @default.
• W4280494007 date "2022-06-01" @default.
• W4280494007 modified "2023-10-01" @default.
• W4280494007 title "Reactive arthritis following COVID-19 vaccination with BNT162b2" @default.
• W4280494007 cites W1998937203 @default.
• W4280494007 cites W2029376813 @default.
• W4280494007 cites W3149183308 @default.
• W4280494007 cites W3150660033 @default.
• W4280494007 cites W3185683543 @default.
• W4280494007 cites W3185793905 @default.
• W4280494007 cites W3201227151 @default.
• W4280494007 cites W3205403389 @default.
• W4280494007 cites W3212304343 @default.
• W4280494007 cites W4286933894 @default.
• W4280494007 doi "https://doi.org/10.1016/j.jdcr.2022.04.026" @default.
• W4280494007 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/35571454" @default.
• W4280494007 hasPublicationYear "2022" @default.
• W4280494007 type Work @default.
• W4280494007 citedByCount "7" @default.
• W4280494007 countsByYear W42804940072022 @default.
• W4280494007 countsByYear W42804940072023 @default.
• W4280494007 crossrefType "journal-article" @default.
• W4280494007 hasAuthorship W4280494007A5064411755 @default.
• W4280494007 hasAuthorship W4280494007A5076263419 @default.
• W4280494007 hasAuthorship W4280494007A5086169812 @default.
• W4280494007 hasBestOaLocation W42804940071 @default.
• W4280494007 hasConcept C116675565 @default.
• W4280494007 hasConcept C126322002 @default.
• W4280494007 hasConcept C159047783 @default.
• W4280494007 hasConcept C17744445 @default.
• W4280494007 hasConcept C199539241 @default.
• W4280494007 hasConcept C203014093 @default.
• W4280494007 hasConcept C22070199 @default.
• W4280494007 hasConcept C2777077863 @default.
• W4280494007 hasConcept C2779134260 @default.
• W4280494007 hasConcept C2779473830 @default.
• W4280494007 hasConcept C2909376813 @default.
• W4280494007 hasConcept C3006700255 @default.
• W4280494007 hasConcept C3007834351 @default.
• W4280494007 hasConcept C3008058167 @default.
• W4280494007 hasConcept C524204448 @default.
• W4280494007 hasConcept C71924100 @default.
• W4280494007 hasConceptScore W4280494007C116675565 @default.
• W4280494007 hasConceptScore W4280494007C126322002 @default.
• W4280494007 hasConceptScore W4280494007C159047783 @default.
• W4280494007 hasConceptScore W4280494007C17744445 @default.
• W4280494007 hasConceptScore W4280494007C199539241 @default.
• W4280494007 hasConceptScore W4280494007C203014093 @default.
• W4280494007 hasConceptScore W4280494007C22070199 @default.
• W4280494007 hasConceptScore W4280494007C2777077863 @default.
• W4280494007 hasConceptScore W4280494007C2779134260 @default.
• W4280494007 hasConceptScore W4280494007C2779473830 @default.
• W4280494007 hasConceptScore W4280494007C2909376813 @default.
• W4280494007 hasConceptScore W4280494007C3006700255 @default.
• W4280494007 hasConceptScore W4280494007C3007834351 @default.
• W4280494007 hasConceptScore W4280494007C3008058167 @default.
• W4280494007 hasConceptScore W4280494007C524204448 @default.
• W4280494007 hasConceptScore W4280494007C71924100 @default.
• W4280494007 hasLocation W42804940071 @default.
• W4280494007 hasLocation W42804940072 @default.
• W4280494007 hasLocation W42804940073 @default.
• W4280494007 hasOpenAccess W4280494007 @default.
• W4280494007 hasPrimaryLocation W42804940071 @default.
• W4280494007 hasRelatedWork W3005417802 @default.
• W4280494007 hasRelatedWork W3009669391 @default.
• W4280494007 hasRelatedWork W3020699490 @default.
• W4280494007 hasRelatedWork W3031607536 @default.
• W4280494007 hasRelatedWork W3084498529 @default.
• W4280494007 hasRelatedWork W3127693599 @default.
• W4280494007 hasRelatedWork W3194420125 @default.
• W4280494007 hasRelatedWork W4206419631 @default.
• W4280494007 hasRelatedWork W4210401150 @default.
• W4280494007 hasRelatedWork W3127156785 @default.
• W4280494007 hasVolume "24" @default.
• W4280494007 isParatext "false" @default.
• W4280494007 isRetracted "false" @default.
• W4280494007 workType "article" @default.