To the Editor:
We read the recent paper by Sgalla and colleagues reporting the potential relationship between coronavirus disease (COVID-19) vaccination and idiopathic pulmonary fibrosis (IPF) (1) with great interest.
We would also like to cautiously share our experience with a patient who developed interstitial lung disease (ILD) exacerbation after receiving COVID-19 vaccination. The patient, a 72-year-old man, had slowly progressive pleuroparenchymal fibroelastosis. He presented 5 days after his second COVID-19 vaccine dose (mRNA, Moderna) with cough, dyspnea, and hypoxia. Computed tomography showed new diffuse ground-glass opacities with patchy areas of consolidation. A detailed history, physical exam, and workup including bronchoscopy did not reveal any causes for the exacerbation. He progressed rapidly to respiratory failure requiring invasive mechanical ventilation. He did not respond to high-dose corticosteroids and tocilizumab, and eventually died.
However, we would like to point out that a temporal relationship between the COVID-19 vaccine and ILD exacerbation does not equate to causality in the previously published case reports (2–5), those described by Sgalla and colleagues (1), and the case we describe. There will be a small number of ILD exacerbations that appear to be temporally related to the COVID-19 vaccine but are in fact random occurrences simply because of the finite background rate of ILD exacerbations and the large numbers of patients with ILD who have received the COVID-19 mRNA vaccine.
These cases do however raise an interesting and important question that can only be answered by larger and likely prospective studies comparing the rate of ILD exacerbations between vaccinated and unvaccinated groups. Until these definitive data are available, we suggest caution in attributing uncertain adverse effects to the COVID-19 vaccines because of the additional risk of misrepresentation of this data in the lay or social media in context of the current antipathy to vaccines (COVID-19 and others) in a subset of the population.
Footnotes
Author Contributions: S.E.-A. and R.R. both contributed to the completion of this correspondence letter.
Originally Published in Press as DOI: 10.1164/rccm.202205-0902LE on May 25, 2022
Author disclosures are available with the text of this letter at www.atsjournals.org.
References
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