https://orcid.org/0000-0003-4313-6592
A 74-year-old Japanese man presented with cough and headache following the Coronavirus disease 2019 (COVID-19) vaccination. Two months before, the day after the third dose of BNT162b2 mRNA COVID-19 vaccination, he presented with a left temporal headache. One month ago, he developed a right temporal headache and cough. His medical history revealed hypertension, for which he was prescribed amlodipine (2.5 mg/day). Physical examination was unremarkable. Auscultation and chest radiograph were normal. His C-reactive protein (6.32 mg/dl) levels and erythrocyte sedimentation rate (79 mm/h) were elevated. Neck and chest contrast-enhanced computed tomography (CT) showed no abnormalities of the lung, thoracic aorta, its branches or pulmonary arteries. Positron emission tomography/CT (PET/CT) showed hyperaccumulation in the thoracic aorta, subclavian, axillary, brachial and temporal arteries (Figure 1a and b). Giant cell arteritis (GCA) was diagnosed. Symptoms improved with oral administration of prednisolone (30 mg/day).
(a) PET/CT showed hyperaccumulation in the thoracic aorta (yellow arrow). (b) PET/CT showed hyperaccumulation in the bilateral temporal arteries (yellow arrows).
GCA is the most common form of vasculitis in older adults, affecting people >50 years of age.1 Common symptoms of GCA include headache, scalp tenderness, jaw claudication, ocular ischemic manifestations and inflammatory arthralgia.1 Cough is a rare initial manifestation of GCA and is often overlooked.2 The mechanism of cough formation is unclear; however, inflammation of the artery adjacent to the cough reflex pathway is thought to cause cough.3 GCA pathophysiology is not fully understood but environmental factors and infections are likely to play a role.4 Additionally, it has been reported that GCA can occur after influenza vaccination and COVID-19 vaccination, which could act as an inflammatory trigger.5 With advances in diagnostic imaging, the identification of macrovascular lesions in GCA patients has improved; PET/CT can identify inflammatory vessels metabolically.6 In conclusion, GCA should be considered in patients with prolonged cough with high inflammatory markers and no pulmonary changes on radiological imaging, which can occur after COVID-19 vaccination.
Conflict of interest: None declared.
