Sex: M
Vaccine: COVID19
Symptoms: Culture, Gram stain, Inappropriate schedule of product administration, Inflammatory marker test, Investigation
Clinical narrative: Pseudogout and septic arthritis; Pseudogout and septic arthritis; Six months earlier, he had received two doses of the Pfizer COVID-19 vaccine; This is a literature report. A 69-year-old male patient received BNT162b2, as dose number unknown, single (Batch/Lot number: unknown) for covid-19 immunisation. The patient's relevant medical history and concomitant medications were not reported. The following information was reported: ARTHRITIS BACTERIAL (medically significant), CHONDROCALCINOSIS (medically significant), outcome "recovering" and all described as "Pseudogout and septic arthritis". Therapeutic measures were taken as a result of arthritis bacterial, chondrocalcinosis. This patient experienced Pseudogout and septic arthritis following the Pfizer BioNTech SARS-CoV-2 vaccination. Drug used noted as ceftriaxone with clinical improvement.  No follow-up attempts are possible. Batch/lot number is not provided, and it cannot be obtained.  Follow-up (28Feb2024): This is a literature report. This is a follow-up report based on the receipt of the publication; the case has been updated to include additional information identified in the publication. Additional information included: Updated reporter information, seriousness of events, new event, medical history, lab data, suspect dosage information  A 69-year-old male with hypertension and right knee osteoarthritis history presented to a hospital with a painful swollen right knee three days after receiving his COVID-19 vaccine booster (Pfizer) on the right deltoid region. Six months earlier, he had received two doses of the Pfizer COVID-19 vaccine with no side effects. However, a day after his booster vaccine, he developed fever, chills, rigors, and body aches. He also experienced right knee pain with no antecedent trauma. The patient was seen in a different health facility and discharged for follow-up with orthopedic surgery. Due to worsening of his right knee pain and swelling, he sought care in a hospital. Upon presentation, he was afebrile (97.6 F), with stable vital signs. The musculoskeletal examination was notable for right knee effusion, tenderness, and reduced range of motion. Laboratory tests showed leukocytosis with a white blood cell (WBC) count of 13 x 10^9 and elevated inflammatory markers, C-reactive protein of 59.6 mg/dL, and erythrocyte sedimentation rate of 90 mm/hour. SARS-CoV-2 RNA was negative. His right knee X-ray revealed moderate tri-compartmental osteoarthritis with suprapatellar joint effusion and evidence of faint chondrocalcinosis. Right knee synovial fluid aspirate appeared turbid with high a WBC (105,080 mm ^9) with 66% olymorphs, positive for intra and extracellular calcium pyrophosphate crystals and gram-positive cocci in chains. The patient underwent right knee arthroscopic irrigation, which revealed purulent effusion in the right knee joint. The right knee aspirate culture revealed beta-hemolytic Streptococcus group C. The patient received a seven-day course of 2 g ceftriaxone during hospitalization. He completed six weeks of antibiotics with clinical improvement and normalization of inflammatory markers.  DISCUSSIONS: The acute septic arthritis in this patient could have triggered the pseudogout flare, as evident in the synovial fluid analysis with extra and intracellular CPP deposits. Moreover, this patient had a pre-existing joint disease and a recent soft tissue injection (COVID-19 vaccination), which might have played a role in the pathogenesis. Although less likely, it is possible that aseptic techniques were not used during the patient's vaccination and possibly resulted in septic arthritis and not necessarily provoked by the vaccine. Conclusions: Flares of pseudogout and gout after COVID-19 vaccination are uncommon. However, with this case report, authors would like to highlight the possibility of similar adverse events and alert healthcare providers to discuss such adverse events with their patients before vaccine administration, especially in susceptible and predisposed individuals. It is also important that existing institutional guidelines and mechanisms to report potential adverse effects post-vaccination are followed to capture all such events to ensure patients' safety.  No follow-up attempts are possible.; Sender's Comments: The event arthritis bacterial, and chondrocalcinosis is conservatively assessed as related to the suspect drug BNT162B2 based on close temporal association but consider also possible contributory effects from medical history of the patient and/or concomitant medications. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees, and Investigators, as appropriate.