The anti-COVID-19 vaccine unveils latent systemic sclerosis

Systemic sclerosis (SSc) is an autoimmune connective disease characterized by extensive fibrosis of the skin, vasculature, and internal organs. The lung, heart, and kidney are frequently involved. The early clinical manifestation is the Raynaud’s phenomenon (RP), but diagnosis may be delayed for years, when systemic involvement is evident or even irreversible. The early identification of SSc could enable prompt treatment and improve prognosis of these patients. A variety of autoimmune conditions after SARS-CoV-2 vaccination have been reported, following which the term “autoimmune post-COVID vaccine syndrome” has been proposed. We present a case of latent diffused SSc with lung involvement in a 40-year-old woman with a history of RP, which became apparent after receiving the first dose of an anti- SARS-CoV-2 vaccine. Case Report: A young non-smoking woman, 40 years old, came for an outpatient cardiological evaluation in October 2021 referred by a pulmonologist who recorded the persistence of tachycardia, chest pain, and dyspnea, suspecting post- SARS-CoV-2 vaccine pericarditis, in June 2021. Echocardiography and laboratory analyses led us to exclude a pathological framework related to the vaccine and we hypothesized a systemic autoimmune disease, e.g., systemic sclerosis. A diagnosis of scleroderma was subsequently confirmed via pulmonary computed tomography and laboratory test. Conclusions Side effects often attributed to the Covid-19 vaccine might not always be caused by it, which can be actually the trigger that unmasks an underlying connective tissue disease. In this case, SARS-CoV-2 vaccination unleashed a latent SSc allowing for an early diagnosis and therefore influencing favorably the prognosis