Journal of Community Medicine & Public Health (ISSN: 2577-2228)

case report

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Methemoglobinemia and Hemolytic Anemia after AstraZeneca COVID-19 Vaccine: A Case-Report

Ayman Kharaba1*, Amal Albeihany2, Reham Kharabah3

1Department of Pulmonary and Critical Care, King Fahad Hospital, Madinah, Saudi Arabia

2Department of Medicine, King Faisal Specialist Hospital, Madinah, Saudi Arabia

3Department of Family Medicine, King Fahad Hospital, Madinah, Saudi Arabia

*Corresponding author: Ayman Kharaba, Consultant, Department of Pulmonary and Critical Care, King Fahad Hospital, Madinah, Saudi Arabia

Received Date: 25 October, 2022

Accepted Date: 31 October, 2022

Published Date: 04 November, 2022

Citation: Kharaba A, Albeihany A, Kharabah R (2022) Methemoglobinemia and Hemolytic Anemia after AstraZeneca COVID-19 Vaccine: A Case-Report. J Community Med Public Health 6: 264. DOI: https://doi.org/10.29011/2577-2228.100264

Abstract

Background: We are reporting a rare case of methemoglobinemia and non-autoimmune hemolytic anemia after AstraZeneca COVID-19 vaccination in the absence of an identifiable precipitating drug. Case presentation: A 33-year old male was admitted with jaundice and hypoxemia after AstraZeneca COVID19 vaccination. Upon admission, he was hypoxic and had normal other vital signs without any signs of respiratory distress. An arterial blood gas revealed a normal partial pressure of oxygen and a high methemoglobin level confirming a methemoglobinemia diagnosis. Hemolysis was diagnosed with decreased levels of hemoglobin, increased levels of indirect bilirubin, increased reticulocyte count, and lactate dehydrogenase level. A hemolytic anemia investigation panel came back normal, including the glucose-6-phosphate dehydrogenase level (G6PD). COVID 19 PCR was negative. A second G6PD test was done in six weeks' follow up, revealing a low level and establishing a G6PD diagnosis. Conclusion: This is the first case to be reported with methemoglobenima and non-autoimmune hemolytic anemia post AstraZeneca vaccine in a patient with G6PD deficiency.

Keywords: COVID19; Hemolysis; Methemoglobinemia; AstraZeneca; Vaccines

Introduction

Since WHO declared COVID19 a pandemic on March 11, 2020, more than 200 million people have been infected worldwide [1].

Four different types of vaccines were evaluated for the necessary criteria of safety and efficacy. The AstraZeneca/Oxford vaccine was among the first to be recognized. As per WHO, many side effects have been reported post AstraZeneca covid19 vaccine, including pain, swelling, tenderness, redness at the injection site, headache, muscle pain, nausea, chills, and fever. Anaphylactic reaction and thromboemolic complications are uncommon side effects [2].We are reporting a rare concurrence of methemoglobinemia and hemolytic anemia post AstraZeneca vaccine.

Case Study

A 33-yearold man without previous medical illness presented to the emergency department with a 6-hour history of body aches, fever associated with yellow sclera, and dark red urine. His symptoms started two hours after the COVID-19 vaccine (Astra Zeneca). He denied any respiratory symptoms. He gave a history of nausea but no vomiting. He has no history of any medication in this period, except for the vaccine. His initial vital signs included a blood pressure of 110/90 mmHg, heart rate of 80, temperature of 37.5 degrees Celsius and respiratory rate of 25/min. His peripheral oximetry showed an 80% saturation in room air. The physical exam was unremarkable, without any signs of respiratory distress. His peripheral oximetry remains at 80% in spite of the 15L non-rebreather facemask oxygen. Initial laboratory exams showed an elevation in lecucytosis, anemia, and elevated total bilirubin, which was mainly indirect at 89%. The chest x-ray was normal (Figure 1) and the CT scan anigo of the chest showed a normal lung field and no evidence of pulmonary embolism (Figure 2). An ABG was done on a non-rebreather mask at a rate of 15 L/min, which showed pH 7.44, pCO2 of 30 mmHg, pO2 of 374, and oxygen saturation of 99.4% while peripheral oxygen saturation of 82% (Figure 3).


Figure 1: Chest X-ray of the patient on day of admission.