A CASE OF COVID-19 PNEUMONIA IN A VACCINATED PATIENT WITH PSORIATIC ARTHRITIS

Abstract

TYPE: Case Report TOPIC: Chest Infections INTRODUCTION: COVID-19 vaccination while on immunosuppressive therapy response may be “weakened” compared to the general population. CASE PRESENTATION: A 69 y/o F with DM2, hypertension, and psoriatic arthritis-on methotrexate/folinic acid and tofacitinib, presented with progressive cough, dyspnea, and fever x 3 days. She had a known exposure to COVID-19. She received two doses of Comirnaty vaccine (Pfizer), and the last dose was a day before admission. On admission, she was tachypneic and hypoxiemic with O2 satt 75% on room air. Chest x-ray showed diffuse patchy opacities, COVID RT-PCR positive. Due to acute hypoxemic respiratory failure, dexamethasone IV and remdesivir IV were given with improvement. On 4th day of admission, she was found unresponsive, bradycardic and pulseless. ACLS protocol was followed, and ROSC was achieved in 3 minutes. Her course was complicated with septic shock requiring pressors, acute kidney failure, shock liver injury, severe lactic acidosis, metabolic acidosis and hyperkalemia. She was found asystolic on the 5th day of admission but she was not coded because she was made DNR. DISCUSSION: Immunogenicity and efficacy of COVID vaccines are uncertain in rheumatic patients who are immunosuppressed. It is known that they are at higher risk for COVID-19 infection with more complications. Therefore, ACR new guidelines emphasize the need of holding immunosuppressive medications for a certain time to increase the efficacy of vaccination. CONCLUSIONS: Patient would have benefit from withholding immunosuppressive medications before and after COVID vaccine administration. DISCLOSURE: Nothing to declare. KEYWORD: covid pneumonia, covid vaccine, psoriatic arthritis, immunosuppressive