Can Pleurisy Occur from Immunizations?
Yes, pleurisy can occur as a rare complication following certain immunizations, though it is extremely uncommon and most reported cases have been associated with COVID-19 vaccines rather than traditional vaccines.
Evidence from COVID-19 Vaccines
The strongest recent evidence comes from COVID-19 vaccine-related cases:
A 78-year-old male developed unilateral pleural effusion with symptoms starting two days after COVID-19 vaccination, ultimately diagnosed as empyema without infectious etiology, suggesting a vaccine-associated inflammatory process 1.
An IgG4-related pleural disease case was documented where a patient developed dyspnea and hypoxia 2 weeks after the second Pfizer COVID-19 vaccine dose, with recurrent pleural effusion requiring thoracoscopic drainage and decortication 2.
Pericarditis (inflammation of the pericardium, anatomically adjacent to the pleura) has been well-documented as a rare but recognized complication of SARS-CoV-2 vaccination, with some cases progressing to difficult-to-treat recurrent disease requiring IL-1 blockade therapy 3.
Evidence from Traditional Vaccines
For conventional vaccines, the evidence is much weaker:
A large pharmacovigilance study using the Vaccine Safety Datalink identified a statistical signal for pleurisy following meningococcal conjugate vaccine (MenACWY-D) in adolescents aged 11-18 years, but further examination suggested this was likely a false signal 4.
Comprehensive ACIP guidelines for vaccinia (smallpox) vaccine from 1991-2001 document numerous complications including eczema vaccinatum, progressive vaccinia, postvaccinial encephalitis, generalized vaccinia, and inadvertent inoculation, but pleurisy is not mentioned among recognized complications 5.
Japanese encephalitis vaccine guidelines document local reactions, systemic effects (fever, headache, malaise), urticaria, angioedema, and rare neurologic events, but do not list pleurisy as a recognized adverse event 5.
Clinical Implications
If pleurisy develops within days to weeks following vaccination, particularly COVID-19 vaccines, consider it as a possible vaccine-related inflammatory complication requiring:
- Thorough evaluation to exclude infectious etiologies (bacterial pneumonia, tuberculosis) 1.
- Imaging with chest CT to characterize the pleural involvement 1, 2.
- Consideration of thoracentesis if effusion is present, with fluid analysis including cell count, chemistry, cultures, and potentially IgG4 levels 2.
- Recognition that most vaccine-related inflammatory complications are self-limited but may require anti-inflammatory therapy 3.
Important Caveats
- The temporal association between vaccination and pleurisy does not automatically establish causation—other etiologies must be systematically excluded 1, 4.
- The risk-benefit ratio of vaccination remains overwhelmingly favorable, as pleurisy following vaccination is exceedingly rare compared to the morbidity and mortality prevented by immunization 6.
- Immunocompromised individuals may have different risk profiles for both vaccine complications and pleural disease from opportunistic infections 7.