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• W4387249961 abstract "SESSION TITLE: Biotechnology Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION: The Moderna Vaccine, an mRNA-1273 COVID-19 vaccine, is a lipid-nanoparticle encapsulated mRNA vaccine developed with advanced technology which in clinical trials showed a 94.1% efficacy at preventing COVID-19 illness and only transient local and systemic reactions. There have been widespread vaccinations and we now report a case of a young woman with immune mediated thrombocytopenia and Coombs positive hemolytic anemia which was diagnosed as secondary Evans syndrome, within three weeks of her first Moderna vaccine dose. CASE PRESENTATION: A 24-year-old female with no significant PMH presented to the ED with lower extremity petechiae and ecchymoses first noted 3 days after her first dose of Moderna vaccine 3 weeks prior. She denied any recent infection, sick contact or use of any new medications and was hemodynamically stable. Physical exam was otherwise unremarkable. Her labs were significant for a Hb of 11.5 with normal MCV (no urinary/GI bleeding per patient), corrected reticulocyte count of 1.2%, platelets of 8,000 and WBC of 3.8. Further lab work showed lactate dehydrogenase (LDH) of 467, haptoglobin <20, positive Coombs test (warm agglutinin IgG) and normal LFTs/INR/PT and PTT. Peripheral smear showed medium sized platelets with no schistocytes. Hepatitis and Covid-19 PCR was negative. Initial diagnosis of immune thrombocytopenic purpura and autoimmune hemolytic anemia was made. She improved remarkably following the administration of oral prednisone (1mg/kg) and intravenous immunoglobulins. Upon discharge her platelets were 69,000 and increased to 247,000 after 2 months. Rheumatological workup revealed positive ANA, elevated dsDNA antibodies to 1506 and positive Chromatin antibody. C3 and C4 complements were also low. She was subsequently diagnosed with Systemic Lupus Erythematosus (SLE). DISCUSSION: Evans syndrome is an autoimmune, extremely rare disorder characterized by either simultaneous or successive development of autoimmune hemolytic anemia and immune thrombocytopenia and/or immune neutropenia in primary (idiopathic) or secondary (associated with an underlying disorder). Use of steroids and intravenous immunoglobulin remain the mainstay of treatment. After inoculation of the vaccine, mRNA is transcribed by ribosomes into SARS-COV2 spike (S) glycoprotein and the spiked protein are displayed by Antigen Presenting Cells leading to T and B-cells mediated immunity. Antibodies against the S glycoprotein have been found to cross react with similar host peptide protein sequences beyond pulmonary tissue. Young females have been identified as being at greater risk for immunological response because the X-chromosome hosts genes involved in immune response and about 10% of microRNA that indirectly control the immune system. CONCLUSIONS: This manuscript highlights an immune mediated response to the mRNA-1273 COVID-19 vaccine. It appears that the vaccine could serve as a trigger for autoimmunity in individuals who are genetically predisposed or have underlying autoimmune disease although the exact mechanism remains unclear. REFERENCE #1: Shaikh H, Mewawalla P. Evans syndrome. StatPearls [Internet]. 2020. REFERENCE #2: Michel M, Chanet V, Dechartres A, Morin A-S, Piette J-C, Cirasino L, et al. The spectrum of Evans syndrome in adults: new insight into the disease based on the analysis of 68 cases. Blood, The Journal of the American Society of Hematology. 2009;114(15):3167-72. REFERENCE #3: Vojdani A., Kharrazian D. Potential antigenic cross-reactivity between SARS-CoV-2 and human tissue with a possible link to an increase in autoimmune diseases. Clin. Immunol. 2020;217:108480. DISCLOSURES: No relevant relationships by Christiana Atuaka No relevant relationships by Claudia De Araujo Duarte No relevant relationships by Arafat Farooqui No relevant relationships by Michael Marcelin No relevant relationships by CHIBUZO OKOYE No relevant relationships by Syed Mohammad Mazhar Uddin" @default.
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• W4387249961 date "2023-10-01" @default.
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• W4387249961 title "A RARE CASE OF EVANS SYNDROME FOLLOWING FIRST DOSE OF COVID MODERNA VACCINE" @default.
• W4387249961 doi "https://doi.org/10.1016/j.chest.2023.07.140" @default.
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