Dysautonomia Following Tetanus, Diphtheria, and Pertussis Vaccine (Tdap): The First Case of Extreme Cachexia Caused by Autoimmune/Inflammatory Syndrome Induced by Adjuvants (ASIA Syndrome) in a Human

Autoimmune/inflammatory Syndrome Induced by Adjuvants (ASIA; Shoenfeld’s syndrome) comprehends a group of autoimmune conditions that flourish in genetically predisposed individuals, following an external stimulus by the so-called adjuvants. Many adjuvants were described, such as vaccines, aluminum and other metals, silicone, tattoos, among others. Those conditions entail defined diseases, such as sarcoidosis and Sjogren’s syndrome, and generalized complex symptoms, for example, fatigue, sleep disturbance, orthostatic intolerance, and other dysautonomic manifestations. Those complaints were previously associated with autoantibodies against nervous system autonomic receptors, especially antibeta 1 adrenergic receptor antibodies, suggesting the autoimmune component of the condition. Here we report on a case of an 18-year-old woman who presented with extreme cachexia due to severe dysautonomia caused by the ASIA syndrome induced by the tetanus, diphtheria, and pertussis vaccine (Tdap).

An Unusual Case of “Conjugal” Polymyalgia Rheumatica after SARS-CoV-2 Vaccination

The rare occurrence of polymyalgia rheumatica (PMR) in married couples has been reported in the literature. Susceptibility to PMR is contributed by genetic and environmental factors and cases of PMR developing after influenza vaccine have also been described, in a debated phenomenon known as ‘ASIA’ syndrome. We report the case of two cohabitating married patients developing PMR few weeks after the first dose of ChAdOx1-S SARS-CoV-2 vaccine. Both patients presented with typical symptoms suggestive of PMR. Laboratory findings and ultrasound examination confirmed the diagnosis. Glucocorticoid therapy led to rapid improvment of symptoms. Anti-receptor-binding domain IgG titre was tested and, eight weeks after vaccination, both patients showed no antibody response. It has been suggested that vaccines might trigger autoimmune or inflammatory states in predisposed individuals and various hypotheses have been made regarding the pathogenesis of PMR. Although the causative effect of vaccines cannot be determined, the close temporal correlation observed in our case supports the potential role of environmental factors in triggering the onset of PMR. However, the literature indicates that post-COVID19 vaccination immune-mediated or inflammatory adverse events are extremely rare and vaccination should be encouraged since the benefit largely outweighs possible risks.

Cutaneous and Ganglion Sarcoidosis Induced by Polycaprolactone Facial Filler: A New Expression of ASIA Syndrome?

Dermal fillers are applied using a minimally invasive technique with a good safety profile. However, they can have side effects. We present the case of a patient who, 2 months after undergoing polycaprolactone (Ellansé®) injections, developed nodular facial and nodal lesions that were compatible with sarcoidosis on histology. This complication has not been previously described for polycaprolactone and could be the expression of an autoimmune syndrome induced by adjuvants.

AUTOIMMUNE/INFLAMMATORYSYNDROMEINDUCEDBYADJUVANTS (ASIA) - REVISION

The autoimmune/inflammatory syndrome induced by adjuvants (ASIA), also known as Shoenfeld’s syndrome, encompasses several autoimmune conditions andphenomena that are induced following the exposure to substances with adjuvant activity. The disease spectrum is heterogeneous in respect to clinical presentation as well as severity of the clinical manifestations. Some genetically predisposed individuals can develop generalized non-specific symptoms, autoantibody production, new onset, or worsening of disease presentation. In this review, we focus on the current knowledge presented in the literature on ASIA syndrome, increasing awareness about the basic concepts and highlight the amount of data accumulated in the last few years concerning the relationship between various adjuvants and autoimmunity.

Three Cases of Subacute Thyroiditis Following SARS-CoV-2 Vaccine: Post-vaccination ASIA Syndrome

Context Autoimmune/inflammatory syndrome induced by adjuvants (ASIA syndrome) can be seen as a post-vaccination phenomenon that occurs after exposure to adjuvants in vaccines that increase the immune responses. There is very limited data regarding ASIA syndrome following SARS-CoV-2 vaccines. Objectives This work aims to report cases of subacute thyroiditis related to the SARS-CoV-2 vaccine. Methods We describe the clinical, laboratory, and imaging features of three cases of subacute thyroiditis after inactivated SARS-CoV-2 vaccine (CoronaVac®). Three female healthcare workers have applied to our clinic with anterior neck pain and fatigue four to seven days after SARS-CoV-2 vaccination. Two of them were in the breastfeeding period. They were negative for thyroid antibodies, and there was no previous history of thyroid disease or upper respiratory tract infection, or COVID-19. Laboratory test results and imaging findings were consistent with subacute thyroiditis. Results SARS-CoV-2 vaccination can lead to subacute thyroiditis as a phenomenon of ASIA syndrome. Subacute thyroiditis may develop within a few days after the SARS-CoV-2 vaccination. Being in the postpartum period may be a facilitating factor for the development of ASIA syndrome after the SARS-CoV-2 vaccination. Conclusions This is the first report of subacute thyroiditis as a phenomenon of ASIA syndrome after inactivated COVID-19 vaccination. Clinicians should be aware that subacute thyroiditis may develop as a manifestation of ASIA syndrome after the inactive SARS-CoV-2 vaccine.

POS0422 PANNICULITIS AS A MANIFESTATION OF AN AUTOIMMUNE/AUTOINFLAMMATORY DISEASE

Background:ASIA syndrome or Schonfeld syndrome is an autoimmune/inflammatory condition induced by adjuvants in genetically susceptible individuals with the development of rheumatic diseases (RD), multiple sclerosis, sarcoidosis, and others.Objectives:to characterize the symptoms of panniculitis (Pn) associated with ASIA-syndromeMethods:Within 7 years, ASIA syndrome was diagnosed in 12 women, average age 37.2±7.4, with a referral diagnosis of “Erythema Nodosum” or “Panniculitis”. The duration of the disease was 16.7±3.9 months. In addition to general clinical study, the serum concentration of α-1 antitrypsin, amylase, lipase, ferritin, creatine phosphokinase (CPK), immunological parameters (ANP-Hep2, dsDNA, C3 and C4, CRP, ANCA, Scl-70, antibodies to cardiolipins G and M), computed tomography of the chest organs, pathomorphological and immunohistochemical examination of a biopsy specimen of skin with subcutaneous fat tissue (SFA) from the affected areas.Results:The development of ASIA syndrome was preceded by gluteoplasty using propantriol-1,2,3 (in 4 patients), liposuction (2), biorevitalization with hyaluronic acid (2) and endoprosthetics with breast implants (2), bone metal construction (1) and mesh hernioplasty (1). The clinical picture of Pn was characterized by generalized red-purple painful (VAS pain 55.8±17.3 mm) subcutaneous indurations on the upper limbs and trunk (in 100% of cases), face (16.6%) and lower limbs (33.3%), with ulceration and oily fluid leakage (58.6%). The saucer symptom was recorded in 83.3% of the observed patients. In 66.6% of cases, fever and articular syndrome were observed, in 41.6% – myasthenic syndrome and lymphadenopathy, in 8.3% – xerophthalmia, keratoconjunctivitis dry, xerostomia and recurrent parotitis. In blood tests, leukopenia (up to 2.0x109/l) was identified in 33.3% of patients, a significant increase in the level of creatinine phosphakinase – in 16,6%, a two or more times increase in ESR and CRP – in 100%. All patients demonstrated immunological changes. The morphological picture of the skin and SFA in 75% of cases resembled lobular Pn, in 8.3% – tumor lymphocytes with the immunophenotype of cytotoxic T-lymphocytes: CD3+, CD8+ were detected. The results obtained allowed confirming RD in 8 patients: systemic lupus erythematosus and idiopathic lobular panniculitis in 2 patients (respectively) and 1 in dermatomyositis, systemic scleroderma of Sjogren’s disease, mixed connective tissue disease. One case was diagnosed with sarcoidosis and T-cell lymphoma. In 2 patients after the liposuction procedure the course of Pn was reversible.Conclusion:Diagnosis of Pn associated with ASIA syndrome is a complex task that requires a multidisciplinary approach to verify the diagnosis and treatment tactics.Disclosure of Interests:None declared

Hepatic involvement in patient with asia syndrome

Resumen El nombre de síndrome autoinmune /inflamatorio inducido por adyuvantes (Síndrome ASIA o de Shonefeld) se relaciona con la exposición típicamente de alguna de estas sustancias: vacunas (especialmente papiloma humano), silicona, escualeno, hidróxido de aluminio, parafina líquida, acrilamidas, ácido hialurónico o metacrilato. Puede dar manifestaciones inflamatorias tanto locales como sistémicas. Presentamos el caso de una paciente con prótesis de silicona en mamas y tatuaje de piel y labios, en estudio por hepatitis de perfil colestásico, en la que aparecen lesiones cutáneas que se biopsian (granulomas no necrotizantes), siendo esto clave para el diagnóstico de reacción sarcoidítica.

Growth Performance and Clinicopathological Analyses in Lambs Repetitively Inoculated with Aluminum-Hydroxide Containing Vaccines or Aluminum-Hydroxide Only

Aluminum (Al) hydroxide is an effective adjuvant used in sheep vaccines. However, Al-adjuvants have been implicated as potential contributors to a severe wasting syndrome in sheep—the so-called ovine autoimmune-inflammatory syndrome induced by adjuvants (ASIA syndrome). This work aimed to characterize the effects of the repetitive injection of Al-hydroxide containing products in lambs. Four flocks (Flocks 1–4; n = 21 each) kept under different conditions were studied. Three groups of seven lambs (Vaccine, Adjuvant-only, and Control) were established in each flock. Mild differences in average daily gain and fattening index were observed, indicating a reduced growth performance in Vaccine groups, likely related to short-term episodes of pyrexia and decreased daily intake. Clinical and hematological parameters remained within normal limits. Histology showed no significant differences between groups, although there was a tendency to present a higher frequency of hyperchromatic, shrunken neurons in the lumbar spinal cord in the Adjuvant-only group. Although Al-hydroxide was linked to granulomas at the injection site and behavioral changes in sheep, the results of the present experimental work indicate that injected Al-hydroxide is not enough to fully reproduce the wasting presentation of the ASIA syndrome. Other factors such as sex, breed, age, production system, diet or climate conditions could play a role.