Giant Cell Arteritis is a condition affecting the large arteries, and it can happen together with Polymyalgia Rheumatica. Recently, I posted Polymyalgia Rheumatica: an adverse effect of the COVID jabs.
This article is about case reports of Giant Cell Polyarteritis happening after the COVID “vaccinations.”
Giant Cell Arteritis (GCA) is an inflammation of the inner lining of the large arteries. It can affect the temporal arteries on the sides of the head to cause Temporal Arteritis to cause headaches.
The aorta, the biggest artery coming directly from the heart, can also be affected by GCA and result in aortic dissection and aortic aneurysm, which I will describe below.
Knowing the symptom presentation of temporal arteritis and aortic problems can alert someone if they need to see their physicians right away.
Giant Cell Arteritis with COVID-19
The first report is about a 50-year-old-man diagnosed with COVID-19 from Spain. He had a high fever, cough, and severe headaches with thickening of both temporal arteries.[1]
The patient’s COVID symptoms resolved one month later, but his headaches persisted. Clinical examination revealed swelling and inflammation of his right temple artery.
An ultrasound of the right temporal artery showed a dark halo around the lumen with a marked flow impairment, suggesting arterial wall inflammation. The left temporal artery ultrasound was normal.
Two weeks later, a PET-CT scan showed a slight increase in metabolic activity in the abdominal aorta. No treatment was started. (Note: Steroids are started but on a case-by-case basis.)
After three weeks, the patient was seen again. At that time, his headaches resolved. and a new temporal artery ultrasound showed the resolution of the inflammation of the temporal artery and normal blood flow. The authors did not mention any follow-up imaging of the aorta, and I presume it was not done.
Giant Cell Arteritis after COVID injections
mRNA COVID jabs like the Pfizer BNT162b2 and the Moderna mRNA-1273 contain the instructions for the body to make the SARS-CoV-2 spike protein. The spike protein will elicit an immune response to protect against future exposure to the SARS-CoV-2 virus that causes COVID-19.
However, the spike protein has an affinity to the inner lining of the arteries or the endothelium because they have ACE2 receptors. Once attached to the endothelium, the immune system will cause inflammation. Thus, the arteries can become inflamed after COVID jabs.
A case series from France discussed three patients. One developed Polymyalgia Rheumatica, and two developed GCA soon after the mRNA shots.[2]
Below is a condensed clinical timetable of the three patients. Patient 1 had PMR, and Patients 2 and 3 had GCA. I put a red mark where the patients had the diagnosis of GCA.
Patient 1 had PMR after getting the Pfizer jab. Cases of patients who had PMR after the COVID shots were discussed in Polymyalgia Rheumatica: an adverse effect of the COVID jabs
Patients 2 and 3 had the GCA after the Pfizer and Moderna shots, respectively.
Patient 2 is a 70-year-old woman previously diagnosed with Polymyalgia Rheumatica (PMR) on December 2019. She takes 8 mg of prednisone daily, and her C-Reactive protein (CRP) was slightly increased at ten mg/L without other symptoms.
Note: CRP is a blood test that tells if there is ongoing inflammation or infection.
She received her first (AstraZeneca) and second shots (Pfizer) on March 15 and June 8, respectively. About ten days after the first shot, she developed fatigue and had high CRP levels at 104 mg/l. A positron emission tomography/computed tomography (PET-CT) showed large vessel vasculitis.
Image A below is her baseline PET scan from December 2019. The middle and C images show the PET scan after the second COVID shot, showing the thickened aorta, which I marked with a red rectangle indicative of inflammation.
Note the aorta with thickened walls.
After the PET scan, Prednisone at 40 mg/day was started. One month later, symptoms had decreased, and CRP was at 15 mg/L.
Patient 3 developed a worsening headache seven days after having the COVID shot. She also developed pain in her jaws while chewing. A condition called jaw claudication.
Her CRP was elevated at 190 mg/dl. A biopsy of her temporal artery showed inflammation. She was successfully treated with Prednisone.
Thankfully, all four patients were diagnosed and treated correctly. Untreated temporal arteritis can cause a stroke or blindness, and aortic complications of GCA can get deadly serious.
Aortic aneurysm and Aortic Dissection
The inflamed aorta in Giant cell arteritis can cause aortic aneurysms or dissection. Both require highly specialized care only available in certain hospitals.
An aortic aneurysm is an enlargement of the aorta. It can happen from its source from the heart and extend to the arteries supplying the brain, kidneys, and legs.
They can present as chest pain, stroke, or sudden loss of consciousness.
Aneurysms of more than five centimeters can rupture and require surgical consultation. If an aortic aneurysm leaks or ruptures, the mortality rate is high.
Aortic dissection is when blood travels or dissects within the layers of the aortic wall. Depending on the location, it can present as excruciating severe chest, abdominal, or back pain.
Depending on the location, it may require immediate surgical repair. Emergent blood pressure control is needed. Ruptured aortic aneurysms and aortic dissection can cause sudden deaths.
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References:
- Riera-Martí N, Romaní J, Calvet J. SARS-CoV-2 infection triggering a giant cell arteritis. Med Clin (Engl Ed). 2021 Mar 12;156(5):253-254. doi: 10.1016/j.medcle.2020.11.008. Epub 2021 Mar 11. PMID: 33723520; PMCID: PMC7947219.
- Cadiou S, et al. SARS-CoV-2, polymyalgia rheumatica and giant cell arteritis: COVID-19 vaccine shot as a trigger? Comment on: “Can SARS-CoV-2 trigger relapse of polymyalgia rheumatica?” by Manzo et al. Joint Bone Spine 2021;88:105150. Joint Bone Spine. 2022 Jan;89(1):105282. doi: 10.1016/j.jbspin.2021.105282. Epub 2021 Sep 29. PMID: 34600148; PMCID: PMC8480145.
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