A case of ANCA-associated vasculitis after AZD1222 (Oxford–AstraZeneca) SARS-CoV-2 vaccination: casualty or causality?

Abstract

Two cases of anti-neutrophil cytoplasmic antibody (ANCA)–associated glomerulonephritis after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination have been reported to date, and both appeared after Moderna (mRNA) vaccination.1Sekar A. Campbell R. Tabbara J. Rastogi P. ANCA glomerulonephritis after the Moderna COVID-19 vaccination.Kidney Int. 2021; 100: 473-474Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar,2Anderegg M.A. Liu M. Saganas C. et al.De novo vasculitis after mRNA-1273 (Moderna) vaccination.Kidney Int. 2021; 100: 474-476Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar We report a case of a 63-year-old man with a nonrelevant medical background, previously normal kidney function, and no previous adverse reactions to vaccination. He was admitted to the hospital after noting 3 episodes of hemoptysis 7 days after his first dose of the AZD1222 vaccine. He had taken acetaminophen and acetylsalicylic acid for a flu-like syndrome, which appeared 48 hours after vaccination. Diagnostic workup showed creatinine 257.2 μmol/l with proteinuria ++ and mild hematuria. Chest X-ray showed infiltration in the left lower lung field. Diagnostic tests for SARS-CoV-2 were negative. Anti-myeloperoxidase antibodies (pANCA) were positive (12 UI/ml). Treatment for ANCA-associated vasculitis was initiated (high-dose i.v. glucocorticoids, followed by a tapering course of oral prednisone reduction [60 mg/d for 1 month followed by a decrease of 10 mg every 2 weeks], and oral cyclophosphamide). Plasma exchange was not instituted as the hemoptysis was self-limited without anemia or hemodynamic instability. Kidney biopsy showed focal extracapillary proliferation and crescent formation, resulting in a diagnosis of a focal class of ANCA-associated pauci-immune glomerulonephritis according to the Berden classification (Figure 1). Hemoptysis disappeared during admission, and progressive recovery of kidney function was observed. Creatinine improved initially with high-dose glucocorticoids to 247.5 μmol/l at 5 days after admission, creatinine was 252 μmol/l at discharge after 18 days of admission, and the last creatinine was 184.8 μmol/l after 6 weeks of treatment. Our patient had not developed an antibody response to the SARS-CoV-2 spike protein 2 months after the first AZD1222 vaccine. To our knowledge, no cases of ANCA vasculitis have been reported after viral vector coronavirus disease 2019 vaccines, but they have been described after influenza vaccination.3Watanabe T. Vasculitis following influenza vaccination: a review of the literature.Curr Rheumatol Rev. 2017; 13: 188-196Crossref PubMed Scopus (38) Google Scholar To our knowledge, this is the first case of ANCA vasculitis after the AZD1222 vaccine so far.4Bomback AS, Kudose S, D’Agati VD. De novo and relapsing glomerular diseases after COVID-19 vaccination: what do we know so far [e-pub ahead of print]? Am J Kidney Dis. https://doi.org/10.1053/j.ajkd.2021.06.004. Accessed August 18, 2021.Google Scholar In our patient, causality is based on temporal association, although we cannot demonstrate a direct link with vaccination. ANCA glomerulonephritis after the Moderna COVID-19 vaccinationKidney InternationalVol. 100Issue 2PreviewAs coronavirus disease 2019 (COVID-19) vaccinations are administered globally on a massive scale, rare adverse events are being reported. We report a case of anti–neutrophil cytoplasmic antibody (ANCA) glomerulonephritis 2 weeks after receiving the COVID-19 (Moderna) vaccine. Full-Text PDF De novo vasculitis after mRNA-1273 (Moderna) vaccinationKidney InternationalVol. 100Issue 2PreviewThe mRNA-1273 (Moderna) vaccine is a lipid nanoparticle–encapsulated mRNA-based vaccine that encodes the prefusion stabilized full-length spike protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of the current coronavirus disease 2019 (COVID-19) pandemic. In a randomized placebo-controlled phase 3 trial, the mRNA-1273 (Moderna) vaccine showed high efficacy at preventing COVID-19. Aside from transient local and systemic reactions, no safety concerns were identified. Full-Text PDF Distinct glomerular disease association after vaccination with BNT162b2 and mRNA-1273: a VigiBase analysisKidney InternationalVol. 101Issue 2PreviewWith the worldwide rollout of coronavirus disease 2019 (COVID-19) vaccines, numerous reports of de novo or relapsing glomerular diseases have been published recently.1–4 It has been stressed that associations between vaccination efforts and the onset of disease do not prove causation, but the administration of vaccines and the induction of an immune response might trigger disease activity. Of note, most cases appear to be either IgA nephropathy (IgAN) or minimal change disease,1 with around 30 cases each reported to date. Full-Text PDF