The aim of the present study was to determine humoral and T-cell responses after four doses of mRNA-1273 vaccine in solid organ transplant (SOT) recipients, and to study predictors of immunogenicity, including the role of previous SARS-CoV-2 infection in immunity. Secondarily, safety was also assessed. Liver, heart, and kidney transplant recipients eligible for SARS-CoV-2 vaccination from three different institutions in Barcelona, Spain were included. IgM/IgG antibodies and T cell ELISpot against the S protein four weeks after receiving four consecutive booster doses of the vaccine were analyzed. One hundred and forty-three SOT recipients were included (41% liver, 38% heart, and 21% kidney). The median time from transplantation to vaccination was 6.6 years (SD 7.4). In total, 93% of the patients developed SARS-CoV-2 IgM/IgG antibodies and 94% S-ELISpot positivity. In total, 97% of recipients developed either humoral or cellular response (100% of liver recipients, 95% of heart recipients, and 88% of kidney recipients). Hypogammaglobulinemia was associated with the absence of SARS-CoV-2 IgG/IgM antibodies and S-ELISpot reactivity after vaccination, whereas past symptomatic SARS-CoV-2 infection was associated with SARS-CoV-2 IgG/IgM antibodies and S-ELISpot reactivity. Local and systemic side effects were generally mild or moderate, and no recipients experienced the development of de novo DSA or graft dysfunction following vaccination.

Ascaris lumbricoides is a globally prevalent helminth that can cause hepatobiliary, pancreatic, and pulmonary complications. In immunocompetent individuals, parasitic migration typically provokes marked eosinophilia. However, underlying hematologic malignancies can blunt expected immune responses and obscure early clinical recognition. We report a case involving a 23-year-old female with a new diagnosis of Burkitt lymphoma who presented with severe epigastric pain, obstructive jaundice, and laboratory findings consistent with cholangitis and pancreatitis. Despite biliary drainage and broad-spectrum antibiotics, her condition worsened, with progressive cytopenias, renal failure, and hypoxemia. Chest CT demonstrated a “head cheese” pattern consistent with hypersensitivity pneumonitis. She subsequently expelled a 15 cm Ascaris lumbricoides worm, and stool examination confirmed a heavy infestation. Despite antiparasitic therapy, she developed refractory septic shock and ultimately died. This report underscores an atypical and fatal multisystem presentation of Ascaris infection in the setting of Burkitt lymphoma. Immunosuppression masked classical parasitic indicators, emphasizing the importance of maintaining clinical suspicion for helminthic disease in endemic regions.

This article has been corrected to replace Figure 1A with an unedited photograph of the specimen parallel to a clinical measuring tape. The previous image had distortions in the tape measure created by image editing tools. The journal verified the provenance and authenticity of the data and images in the case report.