An 85-year-old woman developed systemic lupus erythematosus following Shingrix vaccination, marking the first reported case of lupus linked to the recombinant zoster vaccine, according to the recent case study.
The study described the clinical course, diagnostic evaluation, treatment, and outcomes of an elderly patient who developed lupus manifestations shortly after receiving the recombinant zoster vaccine.
The patient, an 85-year-old woman with a history of hypertension and hypothyroidism, presented with asthenia, pleuritic chest pain, and weight loss beginning one week after the first Shingrix dose. Symptoms worsened following the second dose. Imaging confirmed pleural and pericardial effusion without hemodynamic compromise. Laboratory tests revealed elevated C-reactive protein at 44 mg/L (reference normal range: <10 mg/L) and erythrocyte sedimentation rate at 40 mm/h (reference normal range: 1–20 mm/h), with mild thrombocytosis. Serologic evaluation showed a positive antinuclear antibody (ANA) at 1:640 in a homogeneous pattern and anti-cardiolipin IgG of 46 U.GPL (reference normal range: <10 U.GPL). Complement levels were within normal range, and other autoimmune markers—including anti-histone antibodies and direct Coombs test—were negative. Infectious and malignant etiologies were excluded based on microbiologic, cytologic, and flow cytometric analyses of pleural fluid.
Based on the temporal relationship with vaccination, lack of new medications, and autoimmune serologic findings, the researchers, diagnosed vaccine-induced lupus. The patient was treated with prednisone at 15 mg daily, tapered every five days. Within two months, inflammatory markers normalized, pleural and pericardial effusions resolved, and symptoms abated. At one-year follow-up, ANA and anti-cardiolipin IgG antibodies were negative.
To contextualize their findings, researchers, led by Coral Arévalo-Cañas of Servicio de Medicina Interna, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain, conducted a literature review using PubMed, identifying 16 case reports (2010–2025) of vaccine-induced lupus. Notably, 100% (16/16) of these cases were ANA-positive, 75% (12/16) tested positive for anti-dsDNA antibodies, and only 19% (3/16) were positive for anti-histone antibodies, suggesting a serologic pattern distinct from traditional drug-induced lupus.
Given the widespread use of zoster vaccines globally, researchers emphasized the potential public health impact and the need for clinical vigilance, especially in patients presenting with serositis and autoantibody positivity following immunization
The researchers reported no financial support or competing interests.
Source: Clinical Rheumatology