A case report of relapse of minimal change disease after the first dose of Pfizer-BioNTech Covid-19 vaccine in King Abdul-Aziz Specialist Hospital, Taif, Saudi Arabia

Abstract

Background: Documented cases of de novo glomerular disease or relapse of pre-existing glomerular disease was acquired shortly after administration of COVID-19 messenger RNA (mRNA) vaccinations. Objectives: to present a case of a 64-year-old female who received the Pfizer-BioNTech COVID-19 vaccination as a first dose and then experienced a relapse of minimal change disease (MCD) presenting with nephrotic syndrome. Case presentation: The presenting symptom was ankle swelling and frothy urine which started 9 days after the first dose of vaccine. Albumin level was 24 g/L, urine albumin/creatinine ratio was 668 mg/mmol, Creatinine had risen to 1.3 mg/dl, urine analysis showed 3+ protein. light microscopy showed 17 patent glomeruli, one of which was globally sclerosed. There was mild focal increase in mesangial matrix with occasional atrophic tubules with minor interstitial scarring affecting less than 5% of cortical area. There was moderate fibrointimal thickening. In electron microscopy, 100% of podocyte foot process were effaced with microvillation and marked cytoplasmic vacuolation. The findings were consistent with minimal change disease (MCD) with mild chronic renal parenchymal damage. The patient started furosemide 80 mg daily for 21 days after the onset of complaints. prednisolone 1 mg/kg was initiated 1 week and patient`s symptoms improved. The patient achieved a complete remission 4 weeks after initiation of prednisolone. Conclusion: For the best management of MCD as a potential side effect following COVID-19 vaccination, more knowledge is required. Keywords: case, relapse, MCD, Pfizer-BioNTech, Covid-19, Taif