Inflammatory rheumatic diseases developed after COVID-19 vaccination: presentation of a case series and review of the literature.

OBJECTIVE: An increasing number of new on-set autoimmune-inflammatory rheumatic diseases (AIRD) after COVID-19 vaccination has begun to be reported in the literature. In this article, we present our patients with new-onset AIRD after vaccination for COVID-19 and review the literature on the subject. PATIENTS AND METHODS: We investigated the clinical characteristics and laboratory parameters of previously described "newly developed AIRD in individuals recently vaccinated for COVID-19", in 22 cases vaccinated with one of the COVID-19 vaccines (BNT162b2 or CoronaVac) approved in our country. RESULTS: We collected 22 cases (14 female, 63.6%) that developed an AIRD after COVID-19 vaccination. Mean age was 53±14.4 (24-87) years. The interval between the last dose of vaccination and the development of the first complaint was 23.9±19.5 (4-90) days. CoronaVac was administered to four patients, and the BNT162b2 to 18 patients. AIRD-related symptoms developed in 12 patients after the first dose, in 8 patients after the second dose, and in two patients after the third dose. Twelve out of the 22 (54.5%) cases were diagnosed with rheumatoid arthritis, two with SLE, and the remaining eight patients each with leukocytoclastic vasculitis, Sjogren's syndrome, psoriatic arthritis, ankylosing spondylitis, systemic sclerosis, mixed connective tissue disease, eosinophilic granulomatosis with polyangiitis, and inflammatory myositis, respectively. Six patients had a history of documented antecedent COVID-19 infection. CONCLUSIONS: Autoimmune/inflammatory rheumatic diseases may develop after COVID-19 vaccinations. In the era of the COVID-19 pandemic, vaccination should be questioned carefully in newly diagnosed AIRD patients.

Massive lower gastrointestinal bleeding associated with solitary rectal ulcer in a patient with Behçet's disease.

Solitary rectal ulcer syndrome is a rare benign disorder that has a wide range of clinical presentations and variable endoscopic findings which makes it difficult to diagnose and treat. The clinical and endoscopic picture in this condition can also mimic malign ulceration, malignancy or Crohn's disease. Behçet's disease can affect the gastrointestinal tract. However to the best of our knowledge, no case with solitary rectal ulceration has been reported so far in literature. We herein present a patient diagnosed with Behçet's disease admitted to our clinic with rectal bleeding due to solitary rectal ulceration.

Thyroid autoimmunity in patients with Familial Mediterranean Fever: preliminary results.

AIM: We investigated whether there was a significant increase in thyroid autoimmunity in patients with Familial Mediterranean fever (FMF). PATIENTS AND METHODS: In total, 220 patients, consisting of 42 with FMF, 75 with rheumatoid arthritis (RA), and 103 healthy controls, were enrolled. Serum thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), and thyroid autoantibodies (anti-thyroid peroxidase and anti-thyroglobulin) were measured in all participants. RESULTS: After adjustment for age, gender, and smoking status, statistically significant differences between serum levels of anti-thyroglobulin antibody, anti-thyroid peroxidase antibody, and fT3 were found between the groups (all p < 0.001). Serum TSH level did not differ between the groups (p > 0.05). The frequency of autoimmune thyroiditis in FMF group is higher than control group. However, this difference did not reached the level of statistical significance (p > 0.05). CONCLUSIONS: Although statistically not significant, thyroid autoimmunity was observed more frequently in patients with FMF than in healthy controls. Thyroid autoantibodies were significantly higher in patients with FMF. Studies with greater number of patients are required for evaluating the frequency of the autoimmune thyroiditis in patients with FMF.

A case of propylthiouracil-induced antineutrophilic cytoplasmic antibody-positive vasculitis successfully treated with radioactive iodine.

Antineutrophilic cytoplasmic antibody (ANCA) associated vasculitis is one of the rare complications of propylthiouracil treatment. Having a variable clinical spectrum, it may be presented with both skin limited vasculitis and life-threatening systemic vasculitis. In this study, we present a case that developed ANCA-positive vasculitis with skin and kidney involvement (hematuria and proteinuria) six months after propylthiouracil treatment was initiated for toxic nodular goiter. Proteinuria recovered dramatically subsequent to radioactive iodine treatment following ceasing the drug.

Vasculitis induced by zafirlukast therapy.

Zafirlukast is a leukotriene inhibitor that has recently been approved for the prophylaxis of asthma. Although this new product has been well accepted because of its convenient dosing and relatively few side effects, several cases of Churg-Strauss syndrome have been reported to be associated with its use. In this paper we describe the case of a 54-year-old white man with no history of corticosteroid therapy in whom leukocytoclastic vasculitis, hepatitis and eosinophilia developed while he was on zafirlukast therapy for mild asthma.

A case of Churg-Strauss syndrome presenting with cortical blindness.

A 46-year-old woman with a sudden sight loss due to infarction of the occipital lobes is reported. The association of pulmonary disease, digital ischaemia, polyneuropathy and peripheral eosinophilia led to a diagnosis of Churg-Strauss syndrome. Her vision partially improved by a treatment with steroids and monthly i.v. cyclophosphamide. To our knowledge, this is the first case of CSS with a sudden loss of vision due to bilateral occipital infarction.

Smoking and Behçet's disease.

It has recently been claimed that some of the symptoms in patients with Behçet's disease (BD) can be activated after the patient has stopped smoking. In this study we investigated the effect of smoking on the symptoms of Behçet's disease. Fifty asymptomatic current smokers (CS) who promised to stop smoking (group 1) and 60 current non-smokers (NS) (group 2) (21 of them ex-smokers) with BD were examined at the beginning and a week later for the presence of symptoms of BD. Forty-seven of the 50 CS completed the study. Oral aphthous ulcers were observed in 31 (65.9%) of them at the end of the study period. Besides oral aphthous lesions, genital ulcers were detected in two and erythema nodosum in two other patients. Only 15 (25%) group 2 patients developed oral aphthous ulcers during the study period. The difference between the frequencies of oral aphthous lesions in these groups was significant (p=0.0002). We concluded that cessation of cigarette smoking can activate the mucocutaneous symptoms, especially oral aphthous lesions, in patients with BD.