J Korean Med Sci.  2022 Jul;37(26):e204. 10.3346/jkms.2022.37.e204.

A Case Report of MPO-ANCAAssociated Vasculitis Following Heterologous mRNA1273 COVID-19 Booster Vaccination

• Kim BC
• Kim HS
• Han KH
• Han SY
• Jo HA

• KMID: 2531036
• DOI: http://doi.org/10.3346/jkms.2022.37.e204

Abstract

Despite that clinical trials have been examining the safety profile of coronavirus disease 2019 (COVID-19) vaccines, there are concerns about long-term side effects as the number of vaccinations increases. Herein, we report a case of new-onset renal-limited antimyeloperoxidase (MPO) antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis after booster vaccination with the mRNA 1273 (Moderna) vaccine. A 72-year-old woman with no specific past history, and who had a normal renal function, developed ANCAassociated vasculitis following heterologous booster with mRNA1273 (Moderna) vaccine. After a kidney biopsy, she was diagnosed with ANCA-associated pauci-immune crescentic glomerulonephritis. Her renal function and constitutional symptoms have been improved with treatment with plasmapheresis, intravenous cyclophosphamide and steroid pulse therapy (intravenous 500 mg of methylprednisolone sodium succinate for 3 days) followed by a reduced steroid regimen.

Keyword

ANCA-Vasculitis; Heterologous; mRNA1273 COVID-19 Vaccine

Figure

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  Fig. 1 Kidney biopsy showing (A) cellular crescent (white arrow) noted in a glomerulus. Inflammatory cell infiltration and fibrin deposit are also found. Tubules reveal protein and cellular casts in lumina (PAS stain ×200). (B) Ultrastructural examination shows diffuse effacement of foot processes (black arrow) with distorted and fused cytoplasms of podocytes (TEM ×2,000). Scale bar = 10 µm.

Reference

1. Velikova T, Georgiev T. SARS-CoV-2 vaccines and autoimmune diseases amidst the COVID-19 crisis. Rheumatol Int. 2021; 41(3):509–518. PMID: 33515320.

2. Vadalà M, Poddighe D, Laurino C, Palmieri B. Vaccination and autoimmune diseases: is prevention of adverse health effects on the horizon? EPMA J. 2017; 8(3):295–311. PMID: 29021840.

3. Gelzo M, Cacciapuoti S, Pinchera B, De Rosa A, Cernera G, Scialò F, et al. A Transient increase in the serum ANCAs in patients with SARS-CoV-2 infection: a signal of subclinical vasculitis or an epiphenomenon with no clinical manifestations? A pilot study. Viruses. 2021; 13(9):1718. PMID: 34578298.

4. Prabhahar A, Naidu GS, Chauhan P, Sekar A, Sharma A, Sharma A, et al. ANCA-associated vasculitis following ChAdOx1 nCoV19 vaccination: case-based review. Rheumatol Int. 2022; 42(4):749–758. PMID: 35124725.

5. Walsh M, Merkel PA, Peh CA, Szpirt WM, Puéchal X, Fujimoto S, et al. Plasma exchange and glucocorticoids in severe ANCA-associated vasculitis. N Engl J Med. 2020; 382(7):622–631. PMID: 32053298.

6. Shakoor MT, Birkenbach MP, Lynch M. ANCA-associated vasculitis following Pfizer-BioNTech COVID-19 vaccine. Am J Kidney Dis. 2021; 78(4):611–613. PMID: 34280507.

7. Anderegg MA, Liu M, Saganas C, Montani M, Vogt B, Huynh-Do U, et al. De novo vasculitis after mRNA-1273 (Moderna) vaccination. Kidney Int. 2021; 100(2):474–476. PMID: 34087251.

8. Davidovic T, Schimpf J, Sprenger-Mähr H, Abbassi-Nik A, Soleiman A, Zitt E, et al. Novo and relapsing glomerulonephritis following SARS-CoV-2 mRNA vaccination in microscopic polyangiitis. Case Rep Nephrol. 2021; 2021:8400842.

9. Mohammad AJ. An update on the epidemiology of ANCA-associated vasculitis. Rheumatology (Oxford). 2020; 59(Suppl 3):iii42–iii50. PMID: 32348522.

10. Li NL, Coates PT, Rovin BH. COVID-19 vaccination followed by activation of glomerular diseases: does association equal causation? Kidney Int. 2021; 100(5):959–965. PMID: 34534551.

11. Turner JS, O’Halloran JA, Kalaidina E, Kim W, Schmitz AJ, Zhou JQ, et al. SARS-CoV-2 mRNA vaccines induce persistent human germinal centre responses. Nature. 2021; 596(7870):109–113. PMID: 34182569.

12. Teijaro JR, Farber DL. COVID-19 vaccines: modes of immune activation and future challenges. Nat Rev Immunol. 2021; 21(4):195–197. PMID: 33674759.

13. Atmar RL, Lyke KE, Deming ME, Jackson LA, Branche AR, El Sahly HM, et al. Homologous and heterologous Covid-19 booster vaccinations. N Engl J Med. 2022; 386(11):1046–1057. PMID: 35081293.