Case presentation
A 52-year-old female presented to our center with complaints of fever, joint pain, and weakness of all limbs. She developed symptoms 12 days after getting vaccinated with Johnson and Johnson COVID-19 vaccine in late July 2021. The fever occurred for 10 days, intermittent type, and associated with chills and rigor. The joint pain was for 3 days which was acute in onset involving small joints of hands and feet. The joints were tender making her bed ridden. Concurrently she also developed weakness of all four limbs with relatively more weakness in lower limb than upper limbs. She had more proximal weakness than distal weakness. She had hypertension for 12 years for which she was on medication with amlodipine and enalapril. She had history of hysterectomy for uterine malignancy nine years back. She did not suffer from COVID-19 prior to presentation to our center. She is an ex-smoker and consumes alcohol occasionally. She had no drug allergy or use of illicit drugs.
On examination she was ill looking. She had no pallor, icterus, lymphadenopathy, clubbing, or cyanosis. Her blood pressure was 130/70 mm of Hg, pulse rate of 84 beats per minute, respiratory rate of 24 breaths/min, and oxygen saturation of 95% in room air. Systemic examinations were grossly normal.
Peripheral blood smear revealed normocytic normochromic anemia with neutrophilic cytosis. Serologic evaluation was notable for increased C-reactive protein, decreased C3 complement level, normal C4 level, positivity for p-ANCA and c-ANCA (3+). Stool occult blood test was negative. Serology for HbsAg, HIV 1 and 2 antibody, anti-HCV antibody, antinuclear antibody (ANA), leptosira, salmonella, dengue, and scrub typhus were non-reactive. Renal ultrasound showed tiny non-obstructive calculus in both kidneys. The laboratory values are shown in table 1.