Background and Aims

Vaccination has always been considered a possible trigger for autoimmune diseases such as systemic lupus. Since the beginning of the campaign of COVID 19 vaccination, several flare cases of lupus have been reported after vaccination.
We report a case of systemic lupus induced by messenger RNA vaccination against COVID-19 (Comirnaty®, Pfizer/BioNTech) in a 45-year-old woman.

Methods

A 45-year-old woman with no medical history and was not taking any medication. Who presented ten days after the first injection (Comirnaty®), an inflammatory polyadenopathy with fatigue and mild headache.
One month later, despite the persistence of adenopathy, she received a second vaccine injection. She shows a facial and limb rash with bilateral polyarthritis of the knee, ankle, and wrist seven days later. Further, progressive asthenia and an increase in her symptoms have set in over three weeks.
The clinical examination revealed malar rash with centimetric adenopathies, cervical, axillary.
The biological work-up showed autoantibodies with anti-nuclear factors at 1/1280 with anti-native DNA antibodies at 586 IU/ml and positive anti-histone and anti-nucleosome antibodies with low levels of complement fractions. There is no kidney or heart involvement.

Corticosteroids at dose of 1mg/kg by day associated to hydroxychloroquine at dose of 200mg/day was started.

Results

A significant improvement of skin lesions and regression of fatigue and arthralgia after five days of corticosteroids and hydroxychloroquine treatments.

Conclusions

This is the first description of a lupus onset after vaccination with messenger RNA. Two other cases of lupus following COVID 19 vaccination have been reported with non-replicating viral vector vaccines.