臨床および医療症例レポート

Based on the current interest in the complications associated with vaccination against COVID-19, we present this case report of great interest that shows a carrier of familial Mediterranean fever who suffered myopericarditis and pulmonary thrombosis after administration of the BNT162b2 vaccine against COVID-19.

Certain autoimmune disorders may be triggered by COVID-19 vaccination in genetically susceptible persons. A 40-year-old woman had a history of deep vein thrombosis in 2006 coinciding with taking oral contraceptives, and a daughter with familial Mediterranean fever. In January 2021, as part of the COVID-19 vaccination program, she received her first dose of the BNT162b2 vaccination. Thirteen hours after the second dose she presented at the hospital with oppressive chest pain and fever and after several tests, including a cardiac MRI, she was diagnosed of myopericarditis and pulmonary thrombosis. The patient was heterozygous for the c.1772T>CM variant of gene MEFV.

Steroids and immunoglobulins were started, plus rivaroxaban, ivabradine and colchicine, resulting in slow improvement of the symptoms.

Cases have been reported of myocarditis and pericarditis after vaccination with live virus, like smallpox or flu, and more recently with SARS Cov-2 vaccination. Thrombotic events associated with COVID-19 vaccines are currently being carefully studied by the pharmacovigilance systems. The temporal association with vaccination, the serological pattern of immunization, plus the exclusion of other causes must be thoroughly evaluated.

The greater frequency of cases of myocarditis and pericarditis after RNA vaccination in Israel compared to other geographical areas may be related with ethnic and genetic differences. Indeed, the incidence of familial Mediterranean fever is greater in Israel, Armenia, Turkey and other Mediterranean countries. Further study of this would be interesting.

Renal-replacement therapy options should be made available to patients because of the high incidence of chronic kidney disease (CKD) and the expanding number of persons with end-stage renal disease (ESRD) worldwide. Clinical studies have demonstrated the many advantages of peritoneal dialysis (PD) as a home-based dialysis therapy. These advantages include longer preservation of residual renal function, reduced hemodynamic stress, potential for improved patient survival, relatively high patient quality of life and a greater capacity to serve more ESRD patients due to its lower cost and infrastructure requirements.

A 42-year-old man in remission for chronic myeloid leukaemia (CML) was found to have worsening renal function. Computed Tomography (CT) of the urinary system showed a soft tissue lesion of the right distal ureter which had an atypical appearance for primary malignancy. Due to concerns of recurrence, further evaluation with contrast-enhanced Magnetic Resonance Imaging (MRI) was performed revealing the fibrous nature of the lesion. Considering the resultant obstructive uropathy and the need to exclude recurrence of prior haematological malignancy, resection and histological examination was performed. Resection of the affected segment of the right distal ureter was performed with reimplantion (Psoas Hitch) and Heineke-Mikulicz Bladder reconstruction. Histological examination revealed desmoid-type fibromatosis involving the ureter which is extremely rare. We present the diagnostic process and describe the imaging characteristics through multi-planar CT and MRI images of the tumour obtained prior to resection. A discussion of the imaging differential diagnoses is included with companion images. This entity is important to recognise due to the local aggressiveness of this tumour with propensity for recurrence.