COVID–19ワクチン接種後に副腎クリーゼ，たこつぼ心筋症を発症しショックとなり多腺性自己免疫症候群2型の診断に至った1例(A patient with post COVID–19 vaccination presented with convulsions and cardiogenic shock due to adrenal crisis and Takotsubo cardiomyopathy diagnosed with autoimmune polyendocrine syndromes type II and Addison’s disease)

Abstract

ABSTRACT A 49–year–old woman with a history of Basedow’s disease and vitiligo during her 30s was presented with 5 days of dizziness, nausea, and fatigue after being administered the third COVID–19 vaccination and transported via emergency medical service to the emergency department with sudden loss of consciousness and convulsions. Head and whole body computed tomography were normal but laboratory examination showed severe hyponatremia, which could be the cause of severe consciousness disturbance. Similar to what is observed in Takotsubo cardiomyopathy, echocardiography revealed a mid–ventricular and apical heart–wall motion, appearing as hypokinesis; in contrast, the basal segment showed preserved features. The left ventricular dysfunction caused the progressive hypotension and cardiogenic shock. Empiric treatment with corticosteroid considering the adrenal insufficiency, mechanical circulatory support with intra–aortic balloon pumping, and proper correction of hyponatremia were effective. The patient was extubated by day 7, leading to full recovery. Additional tests confirmed the diagnosis of autoimmune polyendocrine syndromes type II (Schmidt syndrome) and Addison’s disease. This case shows that adrenal crisis is caused by the vaccine’s stress and autoimmune reaction in specific individuals. Since it is an acute life–threatening emergency, early identification and prompt management is essential.