Propylthiouracil-Induced Antineutrophil Cytoplasmic Antibody-Associated Vasculitis after COVID-19 Vaccination.

Saki Okuda,Masafumi Sugiyama,Yasuaki Hirooka

doi:10.3390/vaccines9080842

Abstract

We report the case of a patient who developed antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) after receiving the coronavirus disease 2019 (COVID-19) vaccine BNT162b (Pfizer–BioNTech). A 37-year-old Japanese woman had been taking propylthiouracil for Graves’ disease. She had erythema on her forearm on the 12th day after receiving the first dose of the vaccine, fever on the 13th day, and redness and swelling of her left auricle on the 25th day. Her serum myeloperoxidase-ANCA and proteinase 3-ANCA levels, which were negative before the Graves’ disease treatment, were elevated. She had unilateral auricular symptoms but no other typical relapsing polychondritis findings. She was diagnosed with propylthiouracil-induced AAV. She was treated with oral glucocorticoids, and her symptoms improved. Propylthiouracil is considered to be the main cause of the onset of AAV in this case, but it cannot be ruled out that BNT162b may have had some effect on the onset of the disease. Although the development of propylthiouracil-induced AAV in this case may have been incidental and unrelated to the vaccination, this report provides important data for evaluating the safety of the vaccine.

Highlights

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and first detected in the city of Wuhan in China’s Hubei Province, has become a global pandemic
We report here the case of a patient who developed antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) after receiving the COVID-19 vaccine BNT162b
Blood test results showed elevated levels of myeloperoxidase (MPO)-ANCA and proteinase 3 (PR3)-ANCA, which were negative before the patient had received treatment for Graves’ disease, suggesting the presence of propylthiouracil-induced AAV

Summary

Introduction

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and first detected in the city of Wuhan in China’s Hubei Province, has become a global pandemic. A 37-year-old Japanese woman had been taking propylthiouracil for Graves’ disease for about 28 months She received the Pfizer–BioNTech COVID-19 mRNA vaccine BNT162b through her employment as a care worker. A small, round, and slightly raised erythema appeared on the forearm and precordium of the patient on the 12th day after she received the first dose of the vaccine, and a fever in the 37 ◦C range appeared on the 13th day She visited a nearby hospital, underwent a blood test, and was prescribed a topical steroid. Blood test results showed elevated levels of myeloperoxidase (MPO)-ANCA and proteinase 3 (PR3)-ANCA, which were negative before the patient had received treatment for Graves’ disease, suggesting the presence of propylthiouracil-induced AAV. Total bilirubin Aspartate transaminase Alanine aminotransferase Lactate dehydrogenase Creatinine kinase TSH Free thyroxine Immunology: Rheumatoid factor Antinuclear antibody Anti-ds-DNA antibody Anti-GBM antibody

Discussion

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