New-onset Evans syndrome associated with systemic lupus erythematosus after BNT162b2 mRNA COVID-19 vaccination

Int J Hematol. 2022 Mar;115(3):424-427. doi: 10.1007/s12185-021-03243-2. Epub 2021 Oct 23.


Evans syndrome presents as concurrent autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP). Systemic lupus erythematosus (SLE) is the most frequent autoimmune disorder associated with Evans syndrome. We herein report a case of new-onset Evans syndrome associated with SLE after BNT162b2 mRNA coronavirus disease 2019 (COVID-19) vaccination in a 53-year-old woman. Blood examination at diagnosis showed hemolytic anemia with a positive Coombs test and thrombocytopenia. Hypocomplementemia and the presence of lupus anticoagulant indicated a strong association with SLE. Prednisolone administration rapidly restored hemoglobin level and platelet count. This case suggests that mRNA COVID-19 vaccination may cause an autoimmune disorder. Physicians should be aware of this adverse reaction by mRNA COVID-19 vaccination and should consider the benefits and risks of vaccination for each recipient.

Keywords: AIHA; COVID-19 mRNA vaccine; Evans syndrome; ITP; SLE.

Publication types

  • Case Reports

MeSH terms

  • Anemia, Hemolytic, Autoimmune / diagnosis
  • Anemia, Hemolytic, Autoimmune / drug therapy
  • Anemia, Hemolytic, Autoimmune / etiology*
  • BNT162 Vaccine / adverse effects*
  • Female
  • Hematologic Tests / methods
  • Hemoglobins
  • Humans
  • Lupus Erythematosus, Systemic / diagnosis
  • Lupus Erythematosus, Systemic / drug therapy
  • Lupus Erythematosus, Systemic / etiology*
  • Middle Aged
  • Platelet Count
  • Prednisolone / administration & dosage
  • Purpura, Thrombocytopenic, Idiopathic
  • Risk Assessment
  • Thrombocytopenia / diagnosis
  • Thrombocytopenia / drug therapy
  • Thrombocytopenia / etiology*
  • Vaccination / adverse effects*


  • Hemoglobins
  • Prednisolone
  • BNT162 Vaccine

Supplementary concepts

  • Evans Syndrome