Exacerbation of Systemic Lupus Erythematosus After Receiving mRNA-1273-Based Coronavirus Disease 2019 Vaccine

A 41-year-old woman with a history of systemic lupus erythematosus (SLE) experienced a severe exacerbation of her condition following the administration of the mRNA-1273 COVID-19 vaccine. Despite being stable on hydroxychloroquine, she developed fever, worsening erythema, and a butterfly rash after the first dose, and more severe symptoms including high fever, muscle pain, and pleurisy after the second dose. Laboratory tests indicated significant abnormalities, and she was diagnosed with severe SLE exacerbation and suspected hemophagocytic syndrome. Treatment with high-dose methylprednisolone and prednisone led to improvement, and she was discharged after 2 weeks. This case suggests that mRNA vaccines may exacerbate SLE symptoms, particularly in patients with cutaneous manifestations.