COVID-19 infection following third-dose booster COVID-19 vaccination in a spondyloarthritis patient treated with methotrexate: A case report

Abstract

It has been established that getting the coronavirus disease 2019 (COVID-19) vaccination reduces the risk of serious illness, hospitalization, and even death. Since vaccines are not 100% effective at preventing infection, some people who are fully vaccinated will still get COVID19. This report presents the event of COVID-19 infection following a third-dose booster of messenger RNA (mRNA) COVID-19 vaccination in a Thai female patient with spondyloarthritis, whose disease was well controlled by methotrexate, sulfasalazine and indomethacin. She got a full course of inactivated COVID-19 vaccine (Sinovac-CoronaVac vaccine) and one booster shot of mRNA COVID-19 vaccine (Pfizer-BioNTech). Around 3 months after a booster dose, the patient complained of mild rhinitis, and a positive result for COVID-19 through an antigen test kit was presented. According to the powerful immunosuppressive effects of methotrexate, we presume that this drug may impair immune responses that could potentially lead to breakthrough severe acute respiratory syndrome coronavirus 2 infections. Therefore, patients and health-care providers should be concerned about the appropriate duration of methotrexate cessation on an individual basis to improve the immune response to vaccinations, especially for pandemic and epidemic-prone diseases, for example, COVID-19.