Systemic Lupus Induced by Messenger RNA Vaccination.

We report the case of a woman in her 20s who developed systemic lupus erythematosus after messenger RNA vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). She had no medical history and was not taking any medication. She has a twin sister with no medical history. An inflammatory polyadenopathy involving the cervical, axillary, and inguinal regions developed 7 days after the first injection (Comirnaty). She had no other symptoms, notably no fever or fatigue.

One month later, despite the persistence of adenopathy, she received a second vaccine injection, and bilateral polyarthritis of the metacarpophalangeal joints, proximal interphalangeal joints, and wrists developed 7 days later. She also noticed the appearance of typical Raynaud phenomenon (Figure ). At the same time, a progressive asthenia and an increase of her symptoms set in during 3 weeks.

Figure

Timing of onset and resolution of symptoms after RNA vaccination against SARS-CoV-2 and treatment effects. HCQ, hydroxychloroquine.

5She was admitted for further investigation. The clinical examination revealed supracentimetric adenopathies, laterocervical, supraclavicular, axillary, and inguinal, painful to palpation, as well as a discrete hepatomegaly. No skin lesions were observed. The biological work-up showed autoantibodies with antinuclear factors at 1/1280 with anti–native DNA antibodies at 586 IU/mL and positive antihistone and antinucleosome antibodies with consumption of complement and its fractions. Creatinine level was normal without proteinuria. HIV serology was negative. The capillaroscopy was normal. The thoracic and abdomen-pelvic computed tomography scan confirmed hepatomegaly, without splenomegaly or deep adenopathy. A lymph node biopsy was performed without any germ found on direct examination. Tuberculosis polymerase chain reaction came back negative, and cytologic examination revealed a lymphadenitis without tumor proliferation.

We eventually retained the diagnosis of systemic lupus erythematosus induced by vaccination and then initiated treatment with hydroxychloroquine and systemic corticosteroid therapy. All symptoms rapidly regressed under treatment. Skin lesions on the lower limbs compatible with subacute annular lupus (Figure) appeared after the decrease of corticosteroid therapy, which resolved after resumption of the initial dosage.

To our knowledge, this is the first description of lupus occurring after vaccination with messenger RNA. Two other cases of lupus occurring after COVID-19 vaccination have been described but with nonreplicating viral vector vaccines. ,

Lupus cases have also been reported with other nonreplicating viral vector vaccine targets. A search of the French national pharmacovigilance database for this vaccine identified 7 cases of lupus exacerbation in patients previously observed for this condition, which has already been reported. ,

Despite the reported cases, vaccination remains an essential part of the fight against the current pandemic, including in patients with lupus. The reporting of this case is obviously not intended to question the current vaccine strategy but to inform the medical scientific community of the possibility of autoimmune disease induced by messenger RNA vaccines, although extremely rare in view of the number of vaccinations administered to date throughout the world.

Potential Competing Interests

The authors report no competing interests.