Case Report of Management of TAFRO Syndrome after Vaccination with Cyclosporine Treatment
Japan: In a rare medical occurrence shedding light on potential post-vaccination complications, a case of TAFRO syndrome has been reported, marking a significant milestone in understanding and treating this elusive condition. The patient's successful treatment with cyclosporine highlights a promising therapeutic approach in managing TAFRO syndrome, a condition characterized by thrombocytopenia, anasarca (generalized swelling), fever, reticulin fibrosis, and organomegaly.
While previous reports have documented instances of TAFRO syndrome following COVID-19 vaccination, this case is notable for the patient achieving remission and being discharged. Additionally, a renal biopsy was conducted, aligning with findings from prior cases. The positive treatment outcome offers significant insights into managing TAFRO syndrome effectively.
The case, published in BMC Nephrology, concerns an 82-year-old woman who received two doses of the BNT162b2 mRNA vaccine three weeks apart. After two weeks, she was admitted to the hospital with edema accompanied by thrombocytopenia and renal failure.
Following a thorough examination, she received a diagnosis of TAFRO syndrome. She was treated with cyclosporine, steroids, and thrombopoietin receptor agonists. The patient was released from the hospital following a period of remission lasting several months.
TAFRO syndrome is an uncommon condition characterized by generalized edema, thrombocytopenia, organ enlargement, fever, and renal dysfunction.
There have been limited reports linking TAFRO syndrome to vaccines, with few cases undergoing renal biopsy. TAFRO syndrome is frequently severe and can be fatal, and its underlying cause remains unidentified. Here, Yasuyuki Mimura, Hyogo Medical University, 1-1 Mukogawa-Cho, Nishinomiya, Hyogo, Japan, and colleagues presented a case of TAFRO syndrome following vaccination with the COVID-19 vaccine.
"Despite developing TAFRO syndrome post COVID-19 vaccination, a condition known for its severity, the patient responded well to treatment with steroids and cyclosporine, achieving recovery to the extent of being discharged to outpatient care. Any similar post-vaccination condition should prompt consideration of TAFRO syndrome in differential diagnosis," the researchers wrote.
Various conditions, such as adult multisystemic inflammatory syndrome (MIS-A), systemic capillary leak syndrome (SCLS), and idiopathic thrombocytopenic purpura (ITP) have been linked to COVID-19 vaccines. MIS-A is characterized by cytokine-induced organ inflammation leading to multiorgan damage, while SCLS results in systemic edema due to vascular endothelial cell damage, and ITP causes decreased platelet counts due to the production of antiplatelet antibodies.
In TAFRO syndrome, elevated levels of IL-6, VEGF, and platelet-associated IgG are often observed, similar to this case, suggesting a potential overlap with MIS-A, SCLS, and ITP. When encountering unexplained edema and thrombocytopenia following vaccination, clinicians should consider TAFRO syndrome as part of the differential diagnosis. The case report aims to contribute to understanding the TAFRO syndrome's pathogenesis.
In conclusion, a case of TAFRO syndrome is reported that progressed rapidly after vaccination with Pfizer's COVID-19 vaccine but improved to the point that the patient was discharged from the hospital and returned to the hospital as an outpatient after treatment. After reporting this case of TAFRO syndrome and its relation to vaccination, the researchers also reviewed the relevant literature.
Reference:
Mimura, Y., Kojima, K., Fujikawa, A. et al. A case of TAFRO syndrome after vaccination, successfully treated with cyclosporine. BMC Nephrol 25, 196 (2024). https://doi.org/10.1186/s12882-024-03630-x
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