Age: 30.0
Sex: F
Vaccine: COVID19
Symptoms: Blood test, C1 esterase inhibitor test, Idiopathic angioedema, Tryptase
Clinical narrative: IDIOPATHIC BRADYKININ-MEDIATED ANGIOEDEMA; This spontaneous report was received from literature. This report concerned a 32 year old female. The objective of this study was to describe persistent angioedema after covid-19 vaccination: is bradykinin to blame. The patient's weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose, 1 total administered, start therapy date were not reported for covid-19 prophylaxis. The batch number was not reported. Per procedure, no follow-up will be requested for this case. Age at time of vaccination 4 decade old. No concomitant medications were reported.  On an unspecified date (1 day prior), the patient presented to the Emergency Department (ED) for recurrent lip and tongue swelling. The patient was treated with epinephrine with transient improvement and discharged on steroids and antihistamines. On an unspecified date, patient returned to the ED multiple times and was ultimately hospitalized for recurrent angioedema. On an unspecified date, the patient was hospitalized. Number of days of hospitalization was not reported. The patient would be trialed on additional antihistamine medications, including omalizumab, without relief. The patient was again presented to ED and was treated with epinephrine, antihistamines, and steroids. The laboratory test, included Laboratory data (dates unspecified) included: Blood test (C4) (NR: 10-50) 23 mg/dL, Blood test (C1q) (NR: 10.3-20.5) 12.5 mg/dL, C1 esterase inhibitor (level) test (NR: 21-39) 30 mg/dL, C1 esterase inhibitor (function) test (NR: greater than 67 percent) 83 percent, and Tryptase (NR: 2.2-13.2) 1.5 mcg/L and was unremarkable. The patient was given a dose of icatibant with immediate resolution of angioedema.  The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of idiopathic bradykinin-mediated angioedema was not reported. The authors emphasized on the unique presentation of BMA following the Janssen SARS-CoV-2 vaccine. Given this patient's persistent angioedema and lack of sustained clinical response to antihistamines, corticosteroids, and epinephrine, the diagnosis of BMA was made. A search for an underlying etiology, including evaluation for hereditary, acquired, and medication-induced angioedema was unremarkable. This led to a diagnosis of idiopathic bradykinin-mediated angioedema. This case questions whether there was a particular facet of the SARS-CoV-2 vaccine, specifically, responsible for increased bradykinin levels. Homology of the bradykinin motif has been found in the SARS-CoV-2 spike protein; therefore, the antibody response to the SARS-CoV-2 protein may potentially cross-react with bradykinin protein. It was plausible that immune stimulation to the COVID-19 vaccine and subsequent generation of SARS-CoV-2 specific antibodies may have led to excess bradykinin production in our patient.  This report was serious (Hospitalization Caused / Prolonged).; Sender's Comments: V0: 20230201702- idiopathic bradykinin-mediated angioedema. The event has a compatible/suggestive temporal relationship, is unlabeled, and is scientifically plausible. There is no information on any other factors potentially associated with the event. Therefore, this event is considered consistent with vaccine administration.