Age: 19.0
Sex: F
Vaccine: COVID19
Symptoms: Anti-cyclic citrullinated peptide antibody, Antineutrophil cytoplasmic antibody, Bacterial test, Blood culture, C-reactive protein
Clinical narrative: Patient developed isolated sacroiliitis following the Moderna vaccination; This literature-non-study case was reported in a literature article and describes the occurrence of SACROILIITIS (Patient developed isolated sacroiliitis following the Moderna vaccination) in a 19-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 prophylaxis.   LITERATURE REFERENCE:  Concurrent medical conditions included Leg pain.    On an unknown date, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced SACROILIITIS (Patient developed isolated sacroiliitis following the Moderna vaccination) (seriousness criterion hospitalization). The patient was treated with ACETAMINOPHEN;HYDROCODONE at an unspecified dose and frequency; GABAPENTIN at an unspecified dose and frequency; BETAMETHASONE at a dose of 6 milligram and BUPIVACAINE at a dose of 2 milliliter. At the time of the report, SACROILIITIS (Patient developed isolated sacroiliitis following the Moderna vaccination) had resolved.      DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Anti-cyclic citrullinated peptide antibody: Negative. On an unknown date, Antineutrophil cytoplasmic antibody: Negative. On an unknown date, Bacterial test: Negative. On an unknown date, Blood culture: Negative. On an unknown date, C-reactive protein: 15.8 milligram per litre elevated. On an unknown date, Chlamydia test: Negative and Negative. On an unknown date, HIV antibody: Negative. On an unknown date, HIV antigen: Negative. On an unknown date, HLA marker study: Negative. On an unknown date, Hepatitis B surface antigen: Negative. On an unknown date, Hepatitis C antibody: Negative. On an unknown date, Interferon gamma release assay: Negative. On an unknown date, Magnetic resonance imaging: revealed right sacroiliitis involving the inferior two-thirds of the joint.. On an unknown date, Red blood cell sedimentation rate: 64 Second. On an unknown date, Rheumatoid factor: Negative. On an unknown date, SARS-CoV-2 RNA: Negative. On an unknown date, Treponema test: Negative. On an unknown date, Ultrasound scan: (Negative) For Deep vein thrombosis. On an unknown date, X-ray: (Negative) For fractures.     For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter considered SACROILIITIS (Patient developed isolated sacroiliitis following the Moderna vaccination) to be related.    Patient with no significant medical history was initially presented to the emergency department at an outside hospital with complaints of severe right leg pain, which developed 6 hours after receiving a booster shot for the SARS-CoV-2 vaccination. She was subsequently discharged with pain medications. She presented again 6 days later with inability to bear weight on her right leg and pain refractory to nonsteroidal anti-inflammatories (NSAIDs). She stated her leg pain originated in the right buttock region, near the SI joint, and radiated to lateral and posterior thigh. She was normally active and an elite soccer player, who denied any previous injuries or recent trauma. Physical therapy was started as well, but severely limited due to pain.  Patient was subsequently referred to pain management for interventional procedure with plans of sacroiliac (SI) joint injection, once cleared from infectious disease. The patient underwent right SI joint injection, in which a spinal needle was inserted into the inferior portion of the right SI joint. Post procedure, the patient was able to tolerate passive leg motion and started ambulating the next day.  Company comment: This literature non study case concerns a 19-year-old, female patient with no relevant medical history, who experienced the unexpected serious (hospitalization) AESI of sacroiliitis. The event occurred approximately 6 hours after receiving the third dose (booster shot) of mRNA-1273. As reported, patient presented to the emergency department at an outside hospital with complaints of severe right leg pain, which developed 6 hours after receiving a booster shot for the SARS-CoV-2 vaccination. Workup at that time included x-ray negative for fractures and ultrasound negative for deep vein thrombosis. She was subsequently discharged with pain medications. She presented again 6 days later with  inability to bear weight on her right leg and pain refractory to nonsteroidal anti-inflammatories (NSAIDs), hydrocodone-acetaminophen, and gabapentin. She stated her leg pain originated in the right buttock region, near the SI joint, and radiated to lateral and posterior thigh. Patient was normally active and an elite soccer player, who denied any previous injuries or recent trauma. Physical therapy was started as well, but severely limited due to pain. Further workup included magnetic resonance imaging of lumbar spine and SI joints, which revealed right sacroiliitis involving the inferior two thirds of the joint. Patient was later admitted to the hospital for further workup and subsequently referred to pain management for interventional procedure with plans of SI joint injection of betamethasone and 0.25% bupivacaine which was performed after clearing infectious or rheumatoid disease. Following the injection the patient was able to tolerate passive leg motion and started ambulating the next day. Per authors more literature is required to imply causation, but the COVID-19 vaccine could possibly be a new etiology for sacroiliitis and this was a case of isolated sacroiliitis developing after a third dose of the mRNA1273 vaccine, which was successfully treated with SI joint injection after failing medical management. The benefit-risk relationship of mRNA-1273 is not affected by this report.