Age: 52.0
Sex: F
Vaccine: COVID19
Symptoms: Bronchoscopy, COVID-19, Computerised tomogram thorax, Multiple organ dysfunction syndrome, Pulmonary blastomycosis
Clinical narrative: COVID-19; Severe pulmonary blastomycosis; septic shock with multiple organ failure; septic shock with multiple organ failure; This literature-non-study case was reported in a literature article and describes the occurrence of COVID-19 (COVID-19), PULMONARY BLASTOMYCOSIS (Severe pulmonary blastomycosis), SEPTIC SHOCK (septic shock with multiple organ failure) and MULTIPLE ORGAN DYSFUNCTION SYNDROME (septic shock with multiple organ failure) in a 52-year-old female patient who received mRNA-1273 (Spikevax) for COVID-19 prophylaxis.   LITERATURE REFERENCE:  The patient's past medical history included Bariatric surgery. Concurrent medical conditions included Atrial fibrillation and Asthma.    On an unknown date, the patient received first dose of mRNA-1273 (Spikevax) (unknown route) 1 dosage form. On an unknown date, the patient experienced COVID-19 (COVID-19) (seriousness criterion hospitalization), PULMONARY BLASTOMYCOSIS (Severe pulmonary blastomycosis) (seriousness criterion hospitalization), SEPTIC SHOCK (septic shock with multiple organ failure) (seriousness criterion hospitalization prolonged) and MULTIPLE ORGAN DYSFUNCTION SYNDROME (septic shock with multiple organ failure) (seriousness criterion hospitalization prolonged). The patient was treated with REMDESIVIR for COVID-19 pneumonia, at an unspecified dose and frequency; AMPHOTERICIN B for Antifungal treatment, at an unspecified dose and frequency and ITRACONAZOLE for Antifungal treatment, at an unspecified dose and frequency. At the time of the report, COVID-19 (COVID-19), PULMONARY BLASTOMYCOSIS (Severe pulmonary blastomycosis), SEPTIC SHOCK (septic shock with multiple organ failure) and MULTIPLE ORGAN DYSFUNCTION SYNDROME (septic shock with multiple organ failure) was resolving.      DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Bronchoscopy: revealed thick white secretions, with cultures growing blastomyces dermatitidis (after 12 days into admission). On an unknown date, Computerised tomogram thorax: Revealed dense bilateral consolidations, with hypoxic respiratory failure, revealed worsening consolidations (after treatment with steroids, broad spectrum antibiotics, remdesivir) and still with significant bilateral consolidations (at 6 weeks follow up after discharge). On an unknown date, SARS-CoV-2 test: (Positive) Positive.     The action taken with mRNA-1273 (Spikevax) (Unknown) was unknown.   For mRNA-1273 (Spikevax) (Unknown), the reporter did not provide any causality assessments.   No concomitant medication was reported. Patient presented with shortness of breath for 2 weeks. Patient tested positive for COVID-19 on PCR test at the urgent care 4 days prior. Her symptoms progressed despite initial outpatient treatment with steroids and antibiotics. Patient was admitted for treatment of presumed COVID-19 pneumonia. Despite maximal medical management, that included steroids, broad spectrum antibiotics, remedisivir patient failed to improve. Patient developed septic shock with multiple organ failure, subsequently intubated, and due to significant renal failure, initiated on hemodialysis(HD). After several HD sessions, renal function was fully recovered. Patient was successfully extubated 7 days later, but required additional 22 days of medical care and physical therapy before being ready for discharge to rehabilitation facility. It was reported that patient would require at least 12 months of itraconazole therapy.  Company comment: This literature non-study case concerns a 52 year old female patient with relevant medical history of asthma, who experienced the unexpected serious (hospitalization) events of COVID-19, Pulmonary blastomycosis, Septic shock and Multiple organ dysfunction syndrome, about 5 months after receiving the first dose of mRNA-1273 vaccine. Patient presented to the emergency department with shortness of breath for 2 weeks . She had tested positive for COVID-19 on PCR test, 4 days ago. Her symptoms progressed despite initial outpatient treatment with steroids and antibiotics. Chest computed tomography revealed dense bilateral consolidations. Due to hypoxic respiratory failure, she was admitted for treatment of presumed COVID-19 pneumonia, and guideline directed treatment was initiated. Despite maximal medical management with steroids, broad spectrum antibiotics and remdesivir, she failed to improve. Bronchoscopy performed 12 days into the admission revealed thick white secretions, with cultures growing blastomyces dermatitidis. She was diagnosed with Pulmonary blastomycosis which is known to mimic COVID-19 pneumonia.  At this point, she developed septic shock with multiorgan failure. She was subsequently intubated and due to significant renal failure, initiated on hemodialysis. Anti-fungal treatment was initiated with amphotericin B and transitioned to itraconazole afterwards. She required several hemodialysis sessions, after which her renal function fully recovered. She was successfully extubated 7 days later, but required additional 22 days of medical care and physical therapy before being ready for discharge to rehabilitation facility. On the outpatient follow up 6 weeks after discharge, she continued to slowly recover. Repeat CT chest still showed significant bilateral consolidations. She will require at least 12 months of itraconazole therapy.Underlying asthma could be a risk factor for the events. Immunosuppressive therapy initiated in the beginning could be confounding for Pulmonary blastomycosis. The benefit-risk relationship of mRNA-1273 is not affected by this report.; Sender's Comments: This literature non-study case concerns a 52 year old female patient with relevant medical history of asthma, who experienced the unexpected serious (hospitalization) events of COVID-19, Pulmonary blastomycosis, Septic shock and Multiple organ dysfunction syndrome, about 5 months after receiving the first dose of mRNA-1273 vaccine. Patient presented to the emergency department with shortness of breath for 2 weeks . She had tested positive for COVID-19 on PCR test, 4 days ago. Her symptoms progressed despite initial outpatient treatment with steroids and antibiotics. Chest computed tomography revealed dense bilateral consolidations. Due to hypoxic respiratory failure, she was admitted for treatment of presumed COVID-19 pneumonia, and guideline directed treatment was initiated. Despite maximal medical management with steroids, broad spectrum antibiotics and remdesivir, she failed to improve. Bronchoscopy performed 12 days into the admission revealed thick white secretions, with cultures growing blastomyces dermatitidis. She was diagnosed with Pulmonary blastomycosis which is known to mimic COVID-19 pneumonia.  At this point, she developed septic shock with multiorgan failure. She was subsequently intubated and due to significant renal failure, initiated on hemodialysis. Anti-fungal treatment was initiated with amphotericin B and transitioned to itraconazole afterwards. She required several hemodialysis sessions, after which her renal function fully recovered. She was successfully extubated 7 days later, but required additional 22 days of medical care and physical therapy before being ready for discharge to rehabilitation facility. On the outpatient follow up 6 weeks after discharge, she continued to slowly recover. Repeat CT chest still showed significant bilateral consolidations. She will require at least 12 months of itraconazole therapy.Underlying asthma could be a risk factor for the events. Immunosuppressive therapy initiated in the beginning could be confounding for Pulmonary blastomycosis. The benefit-risk relationship of mRNA-1273 is not affected by this report.