Age: 62.0
Sex: M
Vaccine: COVID19
Symptoms: C-reactive protein, COVID-19, Computerised tomogram kidney, Culture tissue specimen, Cutibacterium acnes infection
Clinical narrative: Bilateral shoulder infection; methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia of right shoulder subacromial space; mild COVID-19; Cutibacterium acnes from left acromioclavicular joint; spondylodiscitis with SEA/L5-S1 discitis with osteomyelitis/foot and leg neuropathy; L5-S1 discitis with osteomyelitis; This literature-non-study case was reported in a literature article and describes the occurrence of STAPHYLOCOCCAL BACTERAEMIA (methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia of right shoulder subacromial space), INTERVERTEBRAL DISCITIS (spondylodiscitis with SEA/L5-S1 discitis with osteomyelitis/foot and leg neuropathy), OSTEOMYELITIS (L5-S1 discitis with osteomyelitis), CUTIBACTERIUM ACNES INFECTION (Cutibacterium acnes from left acromioclavicular joint), ARTHRITIS INFECTIVE (Bilateral shoulder infection) and COVID-19 (mild COVID-19) in a 62-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 prophylaxis.   LITERATURE REFERENCE:    Previously administered products included for COVID-19 vaccination: Pfizer BioNTech COVID-19 vaccine on 18-Dec-2020 and Pfizer BioNTech COVID-19 vaccine on 08-Jan-2021. Past adverse reactions to the above products included No adverse event with Pfizer BioNTech COVID-19 vaccine and Pfizer BioNTech COVID-19 vaccine. Concurrent medical conditions included Gastroesophageal reflux disease (occasional omeprazole use) and Degenerative disc disease. Concomitant products included Naproxen sodium for Degenerative disc disease, Omeprazole for Gastroesophageal reflux disease.    On 03-Nov-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 11-Sep-2022, the patient experienced CUTIBACTERIUM ACNES INFECTION (Cutibacterium acnes from left acromioclavicular joint) (seriousness criterion hospitalization) and COVID-19 (mild COVID-19) (seriousness criterion hospitalization). In September 2022, the patient experienced STAPHYLOCOCCAL BACTERAEMIA (methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia of right shoulder subacromial space) (seriousness criteria hospitalization and medically significant), INTERVERTEBRAL DISCITIS (spondylodiscitis with SEA/L5-S1 discitis with osteomyelitis/foot and leg neuropathy) (seriousness criteria hospitalization and medically significant), OSTEOMYELITIS (L5-S1 discitis with osteomyelitis) (seriousness criteria hospitalization and medically significant) and ARTHRITIS INFECTIVE (Bilateral shoulder infection) (seriousness criterion hospitalization). The patient was hospitalized from 11-Sep-2022 to 21-Sep-2022 due to COVID-19, CUTIBACTERIUM ACNES INFECTION, INTERVERTEBRAL DISCITIS and OSTEOMYELITIS, and then from 11-Sep-2022 to 30-Oct-2022 due to STAPHYLOCOCCAL BACTERAEMIA. The patient was treated with Ketorolac tromethamine (Toradol) (intramuscular use) on 09-Sep-2022 at an unspecified dose and frequency; Methylprednisolone at a dose of 4 milligram, 6 tablets taken on the first day; Methylprednisolone at a dose of 4 milligram once a day; Cefazolin sodium (Cefazolin) (intravenous use) on 13-Sep-2022 at a dose of 2 gram every eight hours; Linezolid (oral use) at a dose of 600 milligram twice a day and Remdesivir at an unspecified dose and frequency. On 17-Sep-2022, COVID-19 (mild COVID-19) had resolved. On 26-Oct-2022, STAPHYLOCOCCAL BACTERAEMIA (methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia of right shoulder subacromial space) had resolved. At the time of the report, INTERVERTEBRAL DISCITIS (spondylodiscitis with SEA/L5-S1 discitis with osteomyelitis/foot and leg neuropathy), OSTEOMYELITIS (L5-S1 discitis with osteomyelitis) and CUTIBACTERIUM ACNES INFECTION (Cutibacterium acnes from left acromioclavicular joint) had resolved and ARTHRITIS INFECTIVE (Bilateral shoulder infection) was resolving.      DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 11-Sep-2022, Blood culture: MSSA bacteremia (Initial Hospitalization). On 11-Sep-2022, Magnetic resonance imaging spinal: (day of admission) did not show evidence of infection but did show mild-to-moderate right-sided disc bulges. On 11-Sep-2022, SARS-CoV-2 test: (Positive) Mildly symptomatic COVID-19 (Initial Hospitalization). On 12-Sep-2022, Magnetic resonance imaging head: no evidence of an acute intracranial abnormality. On 12-Sep-2022, Magnetic resonance imaging joint: moderate effusion of acromioclavicular joint and subacromial space of right shoulder.. On 12-Sep-2022, Magnetic resonance imaging spinal: No signs of infection. On 14-Sep-2022, Echocardiogram: Trans-thoracic and trans-esophageal - normal cardiac function, no endocarditis. On 14-Sep-2022, Magnetic resonance imaging spinal: (three days later) did not show evidence of infection but did show mild-to-moderate right-sided disc bulges, arthroscopic surgical debridement left shoulder.. On 14-Sep-2022, Positron emission tomogram: Normal cardiac function. On 15-Sep-2022, Arteriogram: Abdomen and pelvis - normal. In September 2022, Blood creatine phosphokinase: normal (Initial Hospitalization). On 15-Sep-2022, Computerised tomogram kidney: Negative. In September 2022, Myoglobin blood: normal (Initial Hospitalization). On 16-Sep-2022, Magnetic resonance imaging joint: possible residual subacromial infection of right shoulder and possible residual acromioclavicular joint infection of left shoulder. On 17-Sep-2022, Blood culture: Negative. On 04-Oct-2022, Red blood cell sedimentation rate: Increased. On 11-Oct-2022, C-reactive protein: Increased. On 11-Oct-2022, Red blood cell sedimentation rate: Increased. On 21-Oct-2022, Antinuclear antibody: did not have elevated antinuclear antibodies.. On 21-Oct-2022, Rheumatoid factor: Negative. On 25-Oct-2022, Magnetic resonance imaging spinal: Repeat non-contrast MRI - findings consistent with; L5-S1 discitis with osteomyelitis of the adjacent vertebral bodies with associated epidural abscess. On 26-Oct-2022, Culture tissue specimen: no growth. On 08-Nov-2022, C-reactive protein: Normalization. On 08-Nov-2022, White blood cell count: Normalization. In June 2024, Digital radiogram: 20 months after spine debridement surgery show evidence of auto-fusion of the L5-S1 disc space.     For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments.   A previously healthy, non-diabetic, non-smoker orthopedic surgeon presented with a one-week history of mild left-side sciatica-like symptoms and a four-day history of moderate muscle pain, particularly in the shoulders, hips, and thighs. He had no history of arthritis or inflammatory conditions, no significant dysfunction of his shoulders or back/spine, no prior surgeries in these regions, and no chronic musculoskeletal pain disorders. He did not have any other medical problems.  In early September 2022, after assisting with moving heavy items, he experienced left-side sciatica-like symptoms, which he attributed to increased physical activity. Two days later, he developed moderate muscle pain, nocturnal fevers, chills, and sweats. Despite self-medicating with naproxen and a Methylprednisone dose pack, his symptoms worsened, leading to severe bilateral shoulder pain and difficulty performing daily tasks.  On 11 Sep 2022, he was admitted to the hospital with suspected rhabdomyolysis, but his myoglobin and creatinine kinase levels were normal. He tested positive for COVID-19, characterized by significant muscle pain and fatigue without respiratory symptoms. Blood cultures revealed MSSA bacteremia, and MRI scans showed bilateral shoulder infections: MSSA in the right subacromial space and Cutibacterium acnes in the left acromioclavicular joint.  He underwent surgical debridement of both shoulders on 17 Sep 2022. On 21 Sep 2022, he was discharged from the hospital with a plan for an unspecified IV antibiotics for six weeks. On 05-Oct-2022, the patient experienced foot and leg neuropathy.  Despite initial improvement, his ESR and CRP levels remained elevated, and he developed right-side sciatica-like symptoms. A repeat MRI on 25 Oct 2022 revealed L5-S1 discitis with osteomyelitis and an epidural abscess. He was re-admitted to the hospital and underwent spinal debridement and continued antibiotic therapy with cefazolin and oral linezolid. On 30 Oct 2022, he was discharged from the hospital.  He returned to work 95 days after his initial hospitalization, with reduced physical endurance and persistent mild pain in his shoulders and back. Radiographs at 20 months post-surgery showed favorable auto-fusion of the L5-S1 disc space. At the time of completing this report, he was 25 months from his spinal debridement surgery, functioning at approximately 80% of his prior work capacity, with persistent right foot and leg neuropathy and mild back pain.; Reporter's Comments: causality for Staphylococcal bacteraemia, Arthritis infective, Osteomyelitis and Cultibacterium acnes infection was assessed as Not related, due to lack of biological plausibility. causality for Intervertebral discitis was assessed as Not related, due to vaccine´s mechanism of action. The benefit-risk relationship of product is not affected by this report.