Multisystem Inflammation and Organ Dysfunction After BNT162b2 Messenger RNA Coronavirus Disease 2019 Vaccination

Area of Science:

• Vaccinology
• Immunology
• Public Health

Background:

• The U.S. Food and Drug Administration has authorized three COVID-19 vaccines, including the Pfizer-BioNTech mRNA vaccine (BNT162b2).
• Clinical trials and real-world studies show high efficacy and a favorable safety profile for mRNA COVID-19 vaccines.

Observation:

• A previously healthy 20-year-old male developed tinnitus, hematuria, and systemic inflammation shortly after receiving the first dose of the BNT162b2 vaccine.
• The patient rapidly progressed to acute kidney injury, sensorineural hearing loss, ischemic strokes, pericardial effusion, pleural effusions, and systemic capillary leak syndrome.
• Extensive investigations, including cytokine analysis and whole exome sequencing, did not identify a definitive mechanism for these adverse events.

Findings:

• This case highlights a rare instance of severe multisystem inflammation and organ dysfunction following BNT162b2 vaccination.
• The clinical presentation was complex, involving multiple organ systems and requiring intensive medical intervention.
• No specific underlying mechanism was identified despite comprehensive diagnostic efforts.

Implications:

• While the overall safety of the BNT162b2 vaccine is excellent, rare serious adverse events can occur.
• This case underscores the importance of continued surveillance and investigation of rare post-vaccination events.
• Further research may be needed to elucidate potential mechanisms for such rare, severe reactions to mRNA vaccines.