BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the resulting coronavirus 2019 disease (COVID-19) have spread all around the world since 2019 and have affected millions of people. The development of COVID-19 vaccines helped to decelerate the spread of the virus. However, as in the case of vaccines against other infectious diseases, adverse events can also present with COVID-19 vaccines. CASE PRESENTATION: We report here a rare case of a 53-year-old man with knee-joint synovitis, after the first dose of messenger RNA vaccine, with no fever and a negative COVID-19 reverse transcription polymerase chain reaction test. During a clinical examination the suspicion of pyogenic arthritis was excluded by blood tests and by a complex joint effusion examination, including a microbiological and cytological-energy analysis of the synovial fluid. The treatment received by our patient consisted of 3 doses of dexamethasone administered intravenously over a period of 3 days. All the symptoms improved after this therapy, and in the 3-week follow-up period we recorded full recovery with no consequences. CONCLUSION: Case reports on patients undergoing COVID-19 vaccination should be examined in order to detect rare and long-term side-effects. This is the first report to present the outcomes of an ultrastructural analysis of post-vaccination synovitis.

Department of Biomedicine and Laboratory Diagnostics University J E Purkinje and Masaryk Hospital Usti nad Labem Czech Republic

Department of Clinical Immunology and Allergology Faculty of Medicine University Hospital in Hradec Kralove Charles University Prague Hradec Kralove Czech Republic

Department of Histology and Embryology 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Orthopaedics University J E Purkinje and Masaryk Hospital Usti nad Labem Czech Republic

Laboratory for Cerebrospinal Fluid Neuroimmunology Pathology and Special Diagnostics Topelex Prague Czech Republic

Int J Rheum Dis. 2023 Jan;26(1):168. doi: 10.1111/1756-185X.14461. PubMed

Zobrazit více v PubMed

An QJ, Qin DA, Pei JX. Reactive arthritis after COVID‐19 vaccination. Hum Vaccin Immunother. 2021;17(9):2954‐2956. doi:10.1080/21645515.2021.1920274 PubMed DOI PMC

Won JH, Lee H. The current status of drug repositioning and vaccine developments for the COVID‐19 pandemic. Int J Mol Sci. 2020;21(24):9775. doi:10.3390/ijms21249775 PubMed DOI PMC

Selmi C, Gershwin ME. Diagnosis and classification of reactive arthritis. Autoimmun Rev. 2014;13(4–5):546‐549. doi:10.1016/j.autrev.2014.01.005 PubMed DOI

Wendling D, Verhoeven F, Chouk M, Prati C. Can SARS‐CoV‐2 trigger reactive arthritis? Joint Bone Spine. 2021;88(1):105086. doi:10.1016/j.jbspin.2020.105086 PubMed DOI PMC

Kelbich P, Vachata P, Maly V, et al. Neutrophils in extravascular body fluids: cytological‐energy analysis enables rapid, reliable and inexpensive detection of purulent inflammation and tissue damage. Life. 2022;12:160. 10.3390/life12020160 PubMed DOI PMC

Vanaskova E, Kelbich P, Cegan M, Novotny T. Malignant knee joint effusion—a new dimension of laboratory diagnostics. Applied Sciences. 2022;12:994. 10.3390/app12030994 DOI

Dighriri IM, Alhusayni KM, Mobarki AY, et al. Pfizer‐BioNTech COVID‐19 vaccine (BNT162b2) side effects: a systematic review. Cureus. 2022;14(3):e23526. doi:10.7759/cureus.23526 PubMed DOI PMC

Shoenfeld Y, Aron‐Maor A. Vaccination and autoimmunity‐'vaccinosis': a dangerous liaison? J Autoimmun. 2000;14(1):1‐10. doi:10.1006/jaut.1999.0346 PubMed DOI

Enginar AU. Arthritis following COVID‐19 vaccination: report of two cases. Int Immunopharmacol. 2021;101(Pt B):108256. doi:10.1016/j.intimp.2021.108256 PubMed DOI PMC

Baimukhamedov C. Arthritis of the left elbow joint after vaccination against SARS‐CoV‐2 infection. Int J Rheum Dis. 2021;24(9):1218‐1220. doi:10.1111/1756-185X.14202 PubMed DOI PMC

Kelbich P, Hejcl A, Stanek I, Svitilova E, Hanuljakova E, Sames M. Principles of the cytological‐energy analysis of the extravascular body fluids. Biochem Mol Biol J. 2017;3:6.

Ono K, Kishimoto M, Shimasaki T, et al. Reactive arthritis after COVID‐19 infection. RMD Open. 2020;6(2):e001350. doi:10.1136/rmdopen-2020-001350 PubMed DOI PMC

López‐González MD, Peral‐Garrido ML, Calabuig I, et al. Case series of acute arthritis during COVID‐19 admission. Ann Rheum Dis Apr. 2020;80(4):e58. doi:10.1136/annrheumdis-2020-217914 PubMed DOI

Alkindi F, Al‐Nokhatha S, Alseiari K, Alnaqb KA. Reactive hip arthritis and avascular necrosis after severe Covid‐19 infection: a case report and comprehensive review of literature. EMJ. 2022;7(1):48‐55. doi:10.33590/emj/21-00261 DOI

The Cytological Energy Detection of Purulent Inflammation in Synovial Fluid Is Not All Black and White

Response to commentary: Reactive synovitis of the knee joint and COVID-19 vaccination