Table 1.
Laboratory and radiological investigations in the patient, medications prescribed, and diagnosis
| Investigation | Vaccination date— early June 2021 | Onset of symptoms—Day 5 (post‐vaccination) | Day 14 | Day 80 | Day 116 | Days 136–146 (referral to our center) | Days 160–172 | Day 198 (severe joint pain and tenderness; nodules) | Day 206 (methotrexate initiated) |
|---|---|---|---|---|---|---|---|---|---|
| Hemoglobin (g/dl) | 9.3 | 11 | 9 | 10.7 | 10.7 | 10.1 | |||
| Total leukocyte count (/μl) | 10 800 | 18 180 | 18 800 | 18 700 | 27 000 | 15 630 | |||
| Differential leukocyte count (%) | N72 L8 E8 | N67 L20 E8 | N78 L11 E10 | N54 L21 E23 | N26 L15 E55 | N49 L17 E31 | |||
| Absolute eosinophil count (/μl) | 4400 | 14 850 | |||||||
| C‐reactive protein (mg/L) (normal <6) | 47 ↑↑ | Positive (qualitative) | |||||||
| Immunoglobulin E (IU/ml) (normal <200) | >1000 ↑↑ | ||||||||
| SARS‐COV‐2 anti‐spike IgG antibody (AU/ml) (negative < 0.8) | 144 ↑↑ | ||||||||
| T3 (ng/dl)/T4 (µg/dl)/TSH (µIU/ml) | 83/13/4 (normal) | 99.7/9.5/6.9 ↑ | |||||||
| Rheumatoid arthritis factor (IU/ml) (normal <14) | 68.3 ↑ | ||||||||
| Anti‐CCP (U/ml) (normal <17) | 279.3 ↑↑ | ||||||||
| ANA/anti‐ds‐DNA Ab/ANCA (IU/ml) | Negative | ||||||||
| Anti‐centromere/anti‐Scl 70/anti SSA/anti SSB (IU/ml) | Negative | ||||||||
| Anti Jo‐1/anti Smith/anti‐U1‐RNP (IU/ml) | Negative | ||||||||
| Procalcitonin | Normal | ||||||||
| Stool microscopy for ova/cyst/uncommon parasites | Negative | Negative | |||||||
| Electrocardiogram | Normal | ||||||||
| 2D echocardiography | No regional wall motion abnormality, normal left ventricular ejection fraction, Grade 1 diastolic dysfunction | ||||||||
| Cardiac magnetic resonance imaging | Normal | ||||||||
| Creatine kinase‐MB (ng/ml) (normal <4.3) | 2.2 | ||||||||
| Troponin I (ng/ml) (normal <0.4) | <0.01 | ||||||||
| B‐type natriuretic peptide (pg/ml) (normal <100) | 337 ↑ | ||||||||
| General blood picture | Leukocytosis, increased count of morphologically normal eosinophils | ||||||||
| Upper gastrointestinal endoscopy and histopathological examination of the esophageal biopsy specimen | Normal | ||||||||
| Medications prescribed/being consumed | Irregular intake of telmisartan‐amlodipine‐hydrochlorothiazide over the past 2 years for hypertension | Glyceryl trinitrate (sustained release), diltiazem, telmisartan, betahistine, rabeprazole, domperidone, escitalopram, clonazepam (by a local general practitioner)— indications unclear; prescribed for only 7 days; duration of consumption unclear | |||||||
| Amitriptyline, amlodipine‐hydrochlorothiazide combination, telmisartan, pregabalin, methyl cobalamin, cefixime (prescribed by another practitioner)–indications unclear except for antihypertensives; duration of consumption short and unclear | |||||||||
| Ceftriaxone‐sulbactam, amikacin (prescribed by another practitioner)—indication unclear; duration—5 days | |||||||||
| ACR‐EULAR classification criteria score | 9/10 | ||||||||
| Joint distribution: 5 | |||||||||
| Serology: 3 (anti‐CCP> 3X ULN) | |||||||||
| Duration: 0 (<6 weeks‐ confounded by early diagnosis) | |||||||||
| Acute phase reactants: 1 (C‐reactive protein elevated) | |||||||||
Note: The top row mentions the timeline of vaccination, the onset of symptoms, the first referral to our center, and the onset of rheumatoid arthritis symptoms. Some investigations were performed over a range of days and have been mentioned as such. Investigation results of interest are marked in bold.
Measuring units and standard reference values from the concerned lab are mentioned in brackets beside each investigation.
Other parameters (platelet count, mean cell volume, random blood glucose, routine microscopy and culture of urine, and serum levels of urea, creatinine, sodium, potassium, uric acid, alanine aminotransferase, aspartate aminotransferase, total protein, albumin, total and direct bilirubin, alkaline phosphatase, calcium, phosphate) were within normal limits when measured at different time points. These values are not shown.
Abbreviations: 2D, two dimensional; ACR‐EULAR, American College of Rheumatology‐European League Against Rheumatism; ANA, antinuclear antibody; ANCA, anti‐neutrophil cytoplasmic antibody; anti‐ds‐DNA Ab, anti‐double‐stranded DNA antibody; CCP, cyclic citrullinated peptide; COVID‐19, coronavirus disease‐2019; IgG, immunoglobulin G; SARS‐COV‐2, severe acute respiratory syndrome coronavirus 2; TSH, thyroid‐stimulating hormone; ULN, upper limit of normal.