METHODS: A 75-year-old woman who presented with polydipsia and polyuria 9 weeks after contracting COVID-19 and 5 weeks after receiving the SARS-CoV-2 vaccination, leading to the final diagnosis of AVP-D 8 months after the first appearance of symptoms. Interestingly, pituitary magnetic resonance imaging (MRI) still revealed stalk enlargement frequently observed in patients with SARS-CoV-2 vaccination-induced AVP-D. Although this finding could not rule out any malignancies, we additionally measured anti-rabphilin-3A antibodies, a known marker for lymphocytic infundibulo-neurohypophysitis (LINH), and found that the results were positive, strongly suggesting LINH as the cause of this disease. Thus, we avoided pituitary biopsy. At the follow-up MRI conducted 12 months after the initial consultation, enlargement of the pituitary stalk was still observed.
CONCLUSIONS: We experienced a case with LINH probably induced by SARS-CoV-2 vaccination. In SARS-CoV-2 vaccination-related LINH, unlike typical LINH, there is a possibility of persistent pituitary stalk enlargement on MRI images for an extended period, posing challenges in differential diagnosis from other conditions. Pituitary stalk enlargement and positive anti-rabphilin-3A antibodies may help in the diagnosis of AVP-D induced by SARS-CoV-2 vaccination.
方法:一名75岁女性,在感染COVID-19后9周和接受SARS-CoV-2疫苗接种后5周出现多饮和多尿,导致在首次出现症状后8个月最终诊断为AVP-D。有趣的是,垂体磁共振成像(MRI)仍显示在SARS-CoV-2疫苗接种诱导的AVP-D患者中经常观察到茎扩大。尽管这一发现不能排除任何恶性肿瘤,我们还检测了抗狂犬病蛋白-3A抗体,淋巴细胞漏斗-神经垂体炎(LINH)的已知标志物,发现结果是积极的,强烈暗示LINH是这种疾病的原因。因此,我们避免了垂体活检.在初次咨询后12个月进行的MRI随访中,仍观察到垂体柄增大。
结论:我们经历了一例可能由SARS-CoV-2疫苗引起的LINH病例。在SARS-CoV-2疫苗接种相关的LINH中,不像典型的LINH,在MRI图像上有可能持续的垂体柄增大,在与其他疾病的鉴别诊断中提出了挑战。垂体茎增大和抗狂犬病蛋白3A抗体阳性可能有助于诊断SARS-CoV-2疫苗诱导的AVP-D。