Case Report
Eosinophilic Pneumonia Associated to SARS-CoV-2 Vaccine
Neumonía eosinofílica asociada a la vacuna por SARS-CoV-2
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"autoresLista" => "Eusebi Chiner-Vives, Rosa Cordovilla-Pérez, David de la Rosa-Carrillo, Marta García-Clemente, José Luis Izquierdo-Alonso, Remedios Otero-Candelera, Luis Pérez-de Llano, Jacobo Sellares-Torres, José Ignacio de Granda-Orive" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Eusebi" "apellidos" => "Chiner-Vives" ] 1 => array:2 [ "nombre" => "Rosa" "apellidos" => "Cordovilla-Pérez" ] 2 => array:2 [ "nombre" => "David" "apellidos" => "de la Rosa-Carrillo" ] 3 => array:2 [ "nombre" => "Marta" "apellidos" => "García-Clemente" ] 4 => array:2 [ "nombre" => "José Luis" "apellidos" => "Izquierdo-Alonso" ] 5 => array:2 [ "nombre" => "Remedios" "apellidos" => "Otero-Candelera" ] 6 => array:2 [ "nombre" => "Luis" "apellidos" => "Pérez-de Llano" ] 7 => array:2 [ "nombre" => "Jacobo" "apellidos" => "Sellares-Torres" ] 8 => array:2 [ "nombre" => "José Ignacio" "apellidos" => "de Granda-Orive" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => 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array:3 [ "entidad" => "Pathology Department, Centro Hospitalar Vila Nova de Gaia e Espinho, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Neumonía eosinofílica asociada a la vacuna por SARS-CoV-2" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 462 "Ancho" => 1305 "Tamanyo" => 180242 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Chest HRCT: multiple ground glass opacities and interlobular septal thickening; (B) Histopathological findings of transthoracic needle biopsy: On hematoxylin and eosin staining there is lung tissue with alevoli filled by histiocytes and eosinophils, forming “eosinophilic microabscesses”. (Original magnification: 100×).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Eosinophil-associated lung disease often occurs following certain viral infections and is a known complication of past vaccinations for severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) and other viruses.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> However, to date no similar complications have been reported in response to SARS-CoV-2 vaccination. The authors present two unusual cases of eosinophilic pneumonia following SARS-CoV-2 vaccination.</p><p id="par0010" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case 1</span>: A 38-year-old Caucasian female, former smoker, without relevant medical history nor chronic treatment, presented at consultation with a 1-month progressive dyspnea, aggravated during the last week, and dry cough, pleuritic chest pain and an isolated episode of fever (38<span class="elsevierStyleHsp" style=""></span>°C). Initial workup revealed blood eosinophilia (23.8%; 3250/μL) without neutrophilia and increased C-reactive protein (37.7<span class="elsevierStyleHsp" style=""></span>mg/dL) and total IgE (420). A course of Levofloxacin was started. Of note, symptoms initiated two weeks after COVID-19 vaccination. Physical examination was unremarkable. PCR for SARS-CoV-2 was negative. Chest radiography showed airspace consolidation in the right upper lobe. Chest HRCT revealed multiple ground glass opacities and interlobular septal thickening (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Flexible bronchoscopy with BAL analysis revealed eosinophilia (13%) and lymphocytosis (15%). All microbiological and immunological tests were negative. Rearrangement of PDGFRA was assessed and not found. CT-guided transthoracic lung biopsy was suggestive of eosinophilic pneumonia (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Deflazacort 60<span class="elsevierStyleHsp" style=""></span>mg/day was started, with both clinical and radiological resolution.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Case 2</span>: Forty-seven-year-old caucasian female, non-smoker, with history of psoriasis (treated with ustecinumab since 2019) and depression (treated with fluoxetine 20<span class="elsevierStyleHsp" style=""></span>mg/day). She had a history of nonresolving pneumonia in 2009, at that time with documented blood eosinophilia; diagnostic work-up was non-conclusive and spontaneous resolution of symptoms and radiological changes were observed. Regular follow-up did not show clinical/radiological recurrence.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In July 2021, she presented at the emergency department complaining of fatigue and troublesome dry cough for the last 3 weeks. A course of claritromicin was completed, with no symptomatic improvement. Physical examination revealed crackles in the upper lung fields. Initial workup revealed peripheral eosinophilia (10.1–820/μL), with no leukocytosis and normal C-reactive protein. Patient was administered with SARS-COV-2 vaccine four weeks before symptoms appeared. Chest HRCT revealed peripheral and subpleural areas of linear parenchymal densification (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A). Flexible bronchoscopy with BAL analysis revealed eosinophilia (11%). All microbiological and immunological studies were normal, with exception of positive antinuclear antibodies 1/320 with speckled pattern. CT-guided transthoracic lung biopsy was consistent with eosinophilic pneumonia (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). The patient was started on prednisolone 40<span class="elsevierStyleHsp" style=""></span>mg/day, with clinical and radiological resolution at the end of 14 days.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Acute eosinophilic pneumonia (AEP) is a rare disease that can be idiopathic or secondary to innumerous agents.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The type of T-helper immune response induced by vaccination depends on the antigen (e.g. immunization with inactivated SARS-CoV-1; Immunization with the whole spike (S) protein).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> In the past SARS-CoV-1 vaccines have been shown to induce pulmonary eosinophilia in animals after viral challenge<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> and eosinophil-associated type 2 inflammation in reinfection in monkeys.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Eosinophil associated pulmonary disease was also seen subsequently to infection after RSV vaccination<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> and a case of AEP related to influenza vaccination has also been reported.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Moreover, cases of AEP in patients with COVID-19<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> or expressed as a recurrence of respiratory symptoms after COVID-19 recovery were documented.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Since SARS-CoV-1 and SARS-CoV-2 share more than 80% identity,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> it would be no surprise if SARS-CoV-2 vaccines could cause a similar vaccine-associated immunopathology.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In both cases, possible causes of eosinophilic pneumonia, including parasitic infestation, drug-induced eosinophilia, and dust or toxic substance exposure were excluded, therefore the positive temporal relationship between SARS-CoV-2 vaccination and symptoms’ emergence lead the authors to believe that vaccination might be the potential cause of AEP.</p><p id="par0045" class="elsevierStylePara elsevierViewall">With this report, the authors intend to highlight the potential development or recrudescence of eosinophilic lung disease in association with SARS-CoV-2 vaccination.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">The authors contributed equally to the article.</p>" "identificador" => "fn0005" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 462 "Ancho" => 1305 "Tamanyo" => 180242 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Chest HRCT: multiple ground glass opacities and interlobular septal thickening; (B) Histopathological findings of transthoracic needle biopsy: On hematoxylin and eosin staining there is lung tissue with alevoli filled by histiocytes and eosinophils, forming “eosinophilic microabscesses”. (Original magnification: 100×).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 432 "Ancho" => 1255 "Tamanyo" => 175946 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Chest HRCT: peripheral and subpleural areas of linear parenchymal densification; (B) Histopathological findings of transthoracic needle biopsy: Besides the “eosinophilic microabscesses” there is also more evident alveolar thickening, edema and foci of fibrosis. (Original magnification: 100×).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eosinophil responses during COVID-19 infections and coronavirus vaccination" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.W. Lindsley" 1 => "J.T. Schwartz" 2 => "M.E. Rothenberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaci.2020.04.021" "Revista" => array:6 [ "tituloSerie" => "J Allergy Clin Immunol" "fecha" => "2020" "volumen" => "146" "paginaInicial" => "1" "paginaFinal" => "7" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32344056" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute eosinophilic pneumonia associated with SARS-CoV-2 infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Descalzo" 1 => "F. Salvador" 2 => "I. Sansano" 3 => "Ó. Persiva" 4 => "A. Antón" 5 => "D. Clofent" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2020.12.009" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2021" "volumen" => "57" "paginaInicial" => "50" "paginaFinal" => "52" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34629650" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Strategies to prevent SARS-CoV-2-mediated eosinophilic disease in association with COVID-19 vaccination and infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H.U. Simon" 1 => "A.V. Karaulov" 2 => "M.F. Bachmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000509368" "Revista" => array:6 [ "tituloSerie" => "Int Arch Allergy Immunol" "fecha" => "2020" "volumen" => "181" "paginaInicial" => "624" "paginaFinal" => "628" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32544911" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute respiratory failure secondary to eosinophilic pneumonia following influenza vaccination in an elderly man with chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Pornsuriyasak" 1 => "T. Suwatanapongched" 2 => "J. Klaewsongkram" 3 => "S. Buranapraditkun" 4 => "P. Rotjanapan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijid.2014.04.019" "Revista" => array:6 [ "tituloSerie" => "Int J Infect Dis" "fecha" => "2014" "volumen" => "26" "paginaInicial" => "14" "paginaFinal" => "16" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24981428" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute eosinophilic pneumonia accompanied with COVID-19: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K. Murao" 1 => "A. Saito" 2 => "K. Kuronuma" 3 => "Y. Fujiya" 4 => "S. Takahashi" 5 => "H. Chiba" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/rcr2.683" "Revista" => array:5 [ "tituloSerie" => "Respirol Case Rep" "fecha" => "2020" "volumen" => "8" "paginaInicial" => "e00683" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33235798" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/00000058000000S1/v2_202205240744/S0300289621003768/v2_202205240744/en/main.assets" "Apartado" => array:4 [ "identificador" => "93562" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/00000058000000S1/v2_202205240744/S0300289621003768/v2_202205240744/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289621003768?idApp=UINPBA00003Z" ]
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| 2022 April | 227 | 13 | 240 |
| 2022 March | 200 | 19 | 219 |
| 2022 February | 99 | 9 | 108 |
| 2022 January | 151 | 10 | 161 |
| 2021 December | 410 | 12 | 422 |
| 2021 November | 50 | 7 | 57 |
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