Autoimmune manifestations recorded after SARS-CoV-2 vaccination

To present, to the best of our knowledge, the largest African case series of autoimmune manifestations (AIM) after coronavirus disease 2019 (COVID-19) vaccination.

Cases were collected consecutively from March 2021 to December 2022 from the various departments of the university teaching hospital of Monastir. Autoimmunity biomarkers were investigated mainly in the laboratory of immunology of the same hospital. Anti-nuclear antibody (ANA) screening was performed by indirect immunofluorescence on HEp-2 cells (Euroimmun) with a positivity titer ≥1/180. Typing was done by enzyme-linked immunosorbent assay (ELISA; Biosystems) or line-blot (Euroimmun). The assessment of the other autoantibodies was performed with various techniques (indirect immunofluorescence, ELISA, line- blot).

This case series reports 14 patients (age range, 34-69 years; sex ratio, 1:1) who developed AIM after COVID-19 vaccination with the Pfizer BioNTech, Oxford-AstraZeneca, Johnson & Johnson's Janssen, or Sputnik V vaccines between March 2021 and December 2022. The clinical onset occurred 1 week to 2 months after the last administrated dose. Immunological evaluation revealed positive ANA in 13 cases (titer 1/180 to 1/3,200). Autoantibodies typing revealed anti-mitochondria type 2 in 4 cases, anti-SSA in 3 cases, and anti-DFS70 in 2 cases. Nine patients received specific treatments for diagnosed autoimmune diseases (AID), whereas the others showed non-specific immune stimulation, reactive arthritis, myositis, and cerebral venous thrombosis, which improved with symptomatic treatment.

This series suggests a link between severe acute respiratory syndrome coronavirus 2 vaccination and triggered or revealed AID or AIM.