COVID-19 vaccine induced interstitial lung disease

Published:September 19, 2021DOI:


      A 60-year-old man presented with dyspnea four days after the second dose of the coronavirus disease (COVID-19) vaccine. Imaging revealed extensive ground-glass opacification. Blood tests were notable for elevated KL-6 levels. Bronchoalveolar lavage fluid analysis showed increased lymphocyte-dominant inflammatory cells and decreased CD4/CD8 ratio. These findings were consistent with the diagnosis of drug-induced interstitial lung disease (DIILD). To the best of our knowledge, this has never been reported in previous literature. Treatment with glucocorticoids relieved his symptoms. This paper highlights that although extremely rare, COVID-19 vaccine could cause DIILD, and early diagnosis and treatment are crucial to improve patient outcomes.


      To read this article in full you will need to make a payment


      Subscribe to Journal of Infection and Chemotherapy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Johns Hopkins University Coronavirus Resource Center. COVID-19 dash-board by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. (

        • Beigel J.H.
        • Tomashek K.M.
        • Dodd L.E.
        • et al.
        Remdesivir for the treatment of Covid-19 - final report.
        N Engl J Med. 2020; 383: 1813-1826
        • Spinner C.D.
        • Gottlieb R.L.
        • Criner G.J.
        • et al.
        Effect of remdesivir vs standard Care on clinical status at 11 Days in patients with moderate COVID-19: a randomized clinical trial.
        J Am Med Assoc. 2020; 324: 1048-1057
        • Polack F.P.
        • Thomas S.J.
        • Kitchin N.
        • et al.
        Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine.
        N Engl J Med. 2020; 383: 2603-2615
        • Dagan N.
        • Barda N.
        • Kepten E.
        • et al.
        BNT162b2 mRNA Covid-19 vaccine in a nationwide mass vaccination setting.
        N Engl J Med. 2021; 384: 1412-1423
        • Travis W.D.
        • Costabel U.
        • Hansell D.M.
        • et al.
        An official American Thoracic Society/European Respiratory Society statement: update of the international multidisciplinary classification of the idiopathic interstitial pneumonias.
        Am J Respir Crit Care Med. 2013; 188: 733-748
        • Skeoch S.
        • Weatherley N.
        • Swift A.J.
        • et al.
        Drug-induced interstitial lung disease: a systematic review.
        J Clin Med. 2018; 7: 356
        • Raghu G.
        • Collard H.R.
        • Egan J.J.
        • et al.
        An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management.
        Am J Respir Crit Care Med. 2011; 183: 788-824
        • Watanabe S.
        • Waseda Y.
        • Takato H.
        • et al.
        Influenza vaccine-induced interstitial lung disease.
        Eur Respir J. 2013; 41: 474-477
        • Numata T.
        • Hida N.
        • Yazaki K.
        • et al.
        Seasonal influenza vaccine-induced pneumonitis presenting with multiple pulmonary nodules.
        Intern Med. 2018; 57: 707-711
        • Tan L.
        • Testa G.
        • Yung T.
        Diffuse alveolar damage in BCGosis: a rare complication of intravesical bacillus Calmette-Guérin therapy for transitional cell carcinoma.
        Pathology. 1999; 31: 55-56
        • Matsuno O.
        Drug-induced interstitial lung disease: mechanisms and best diagnostic approaches.
        Respir Res. 2012; 13: 39
        • Camus P.
        • Fanton A.
        • Bonniaud P.
        • et al.
        Interstitial lung disease induced by drugs and radiation.
        Respiration. 2004; 71: 301-326
        • Hirata S.
        • Hattori N.
        • Kumagai K.
        • et al.
        Lymphocyte transformation test is not helpful for the diagnosis of methotrexate-induced pneumonitis in patients with rheumatoid arthritis.
        Clin Chim Acta. 2009; 407: 25-29