SHM Converge Scientific Abstract ePoster Gallery-A Novel Case of Acute Eosinophilic Pneumonia Following Mrna Covid-19 Vaccination

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This case report describes a 56-year-old man with hypertension and alcoholic cirrhosis who developed acute eosinophilic pneumonia (AEP) shortly after receiving his first Moderna mRNA COVID-19 vaccine. His dyspnea began two days after vaccination and worsened over three weeks despite outpatient treatment for presumed pneumonia with levofloxacin and azithromycin. He presented hypoxemic with bilateral wheezing, peripheral eosinophilia (23%), thrombocytopenia, and chest CT showing bilateral ground-glass opacities.<br /><br />An extensive infectious and autoimmune workup was negative, including SARS-CoV-2 PCR and testing for several fungal and parasitic infections. Bronchoscopy with bronchoalveolar lavage showed only 8% eosinophils, below the classic diagnostic threshold of 25%, but this was thought to be affected by prior empiric steroid treatment, which also temporarily suppressed peripheral eosinophils to 0%. His serum IgE was markedly elevated.<br /><br />The patient initially improved with high-dose steroids, but symptoms and eosinophilia recurred after steroids were held. He then received methylprednisolone again, with rapid clinical improvement, resolution of eosinophilia, and successful weaning to room air. He was discharged on a prednisone taper and remained in remission.<br /><br />The authors conclude that this is the first reported case of AEP following COVID-19 vaccination. They note that AEP has previously been associated with other vaccines, such as influenza and pneumococcal vaccines. Because of the suspected link, the patient was advised to avoid further mRNA vaccines and consider a viral-vector vaccine instead.

Asset Subtitle

lUKE jOSEPH

Meta Tag

Author List David Ennis, Shashi K. Katukoori, lUKE jOSEPH

Category Clinical Vignettes

Concept Daptomycin-induced acute eosinophilic pneumonia

Concept Eosinophilia

Concept Bronchoalveolar Lavage

Concept Bronchoalveolar lavage eosinophilia

Concept Corticosteroids

Distinguished Non-Finalist

Presenter Organization UAB Internal Medicine

Presenting Author lUKE jOSEPH

Track Adult

Keywords

acute eosinophilic pneumonia

Moderna mRNA COVID-19 vaccine

case report

dyspnea

peripheral eosinophilia

ground-glass opacities

bronchoalveolar lavage

corticosteroid therapy

hypoxemia

vaccine-associated pneumonia

Daptomycin-induced acute eosinophilic pneumonia

Eosinophilia

Bronchoalveolar Lavage

Bronchoalveolar lavage eosinophilia

Corticosteroids