Coronavirus disease 2019 vaccination-induced acute exacerbation in idiopathic pulmonary fibrosis.

We report a rare case of acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) after coronavirus disease 2019 (COVID-19) vaccination. Clinicians should be aware of this COVID-19 vaccination-induced AE in IPF.

CLINICAL IMAGE

A 78‐year‐old Japanese man with diabetes mellitus and idiopathic pulmonary fibrosis (IPF) developed malaise, myalgia and systemic skin rash from the day following first BNT162b2 vaccine (BioNTech/Pfizer) for coronavirus disease 2019 (COVID‐19). Seven days after vaccination, he experienced worsening dyspnea and fever. The symptoms persisted without improvement for 3 weeks. SARS‐CoV‐2 polymerase chain reaction was negative. The culture of sputum and blood tests for potentially infectious pathogens were negative. There was no evidence of left heart failure, pulmonary embolism and aspiration. He had not undergone any recent surgeries or medication changes. Thus, he was diagnosed with acute exacerbation (AE) of IPF after COVID‐19 vaccination (Figure 1A,B) and received intravenous methylprednisolone (mPSL) pulse therapy for 3 days, followed by prednisolone. One month later, his clinical condition and radiological findings had gradually improved (Figure 1C, D).

FIGURE 1

Serial changes in high‐resolution computed tomography (HRCT) of the chest. (A, B) At the initial visit, subpleural honeycombing and reticulation with traction bronchiectasis were existed predominantly in the bilateral lower lobes. In addition, patchy ground‐glass opacities (GGOs) were seen in predominantly affecting the subpleural region of the bilateral lung fields. (C, D) One months after corticosteroids therapy began; interlobular septal thickening and GGOs in both lung fields were improved

Recently, some researchers have reported IPF‐AE after COVID‐19 vaccination. , The pathogenesis of IPF‐AE triggered by COVID‐19 vaccination remains unclear, but COVID‐19 vaccine produces T cell responses, releasing proinflammatory cytokines such as interferon‐γ and interleukin‐2. Although, it is difficult to differentiate idiopathic AE from COVID‐19 vaccination‐induced AE, we suppose that vaccination can trigger AE of IPF characterized by a steroid‐responsive episode

AUTHOR CONTRIBUTIONS

Keishi Sugino was responsible for conceptualization and drafting the manuscript. Keishi Sugino, Hirotaka Ono, Mikako Saito, Masahiro Ando, and Eiyasu Tsuboi analysed and interpreted the clinical and radiological data. All authors read and approved the final manuscript.

CONFLICT OF INTEREST

None declared.

ETHICS STATEMENT

The authors declare that appropriate written informed consent was obtained for the publication of this manuscript and accompanying images.