Abstract
Vaccination against the virus responsible for COVID-19 has become a key in preventing mortality and morbidity related to the infection. Studies have shown that the benefits of vaccination outweigh the risks. However, there are concerns regarding serious adverse events of some vaccines, although they are fortunately rare. Here, we report a case of a 47-year-old female from Kathmandu who presented with high grade fever, dry cough and erythematous rash a week after exposure to the Oxford-AstraZeneca vaccine. She had hepatosplenomegaly, persistent leucocytosis, anaemia and thrombocytosis along with markedly raised inflammatory markers. Her tests for infectious causes and haematological malignancies was negative and she showed no response to multiple antibiotics. Finally, she had a dramatic response to steroids with disappearance of fever and normalization of other laboratory parameters. Hence, she was diagnosed with Adult-onset Still’s Disease (AOSD). She was under methotrexate and prednisolone tapering dose and doing well as at time of writing. The trigger for the disease was hypothesized to be the vaccine because of the strong temporal association.
Highlights
COVID-19 is a major pandemic currently affecting the whole world, and Nepal is noexception
Adult-onset Still’s Disease (AOSD) is a multisystem autoinflammatory disease characterized by high grade fever, inflammatory arthritis, and an evanescent rash
We describe a case of AOSD following administration of the Oxford-AstraZeneca vaccine in Nepal
Summary
COVID-19 is a major pandemic currently affecting the whole world, and Nepal is noexception. AOSD is a rare autoinflammatory disease and diagnosis of this case itself is a challenge, especially in a country like Nepal, where rheumatology is a budding specialty This case were follows only two other reported similar cases after vaccination against COVID-195,6. After three days of fever, she developed itchy erythematous rashes bilaterally involving thighs, legs and hands, especially during the spiking of fever She had received the first dose of the Oxford-AstraZeneca vaccine seven days prior to the onset of fever. The antibiotics were stopped on the seventh day, and she was discharged with prednisolone and methotrexate She is under regular follow-up for her condition as at time of writing this report. During her latest follow-up in September 2021, she was afebrile and had no other symptoms She is currently receiving prednisolone 10 mg daily and methotrexate 15 mg per week as at time of writing
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