ANCA-associated vasculitis following Oxford-AstraZeneca COVID-19 vaccine in Brazil: Is there a causal relationship? A case report

Abstract

This article presents a case of rapidly progressive glomerulonephritis following the Oxford-AstraZeneca COVID-19 vaccine in a female patient 58 years old. After 5 days, she presented fatigue, paleness, arthralgia on hands, knees, ankles, foamy urine, and elevated blood pressure. Exams showed serum creatinine of 2.2 mg/dL (baseline creatinine of 1.0 mg/dL). Urinalysis revealed hematuria, and her 24-h urinary protein excretion was 4.4 g. Additional exams showed hypercholesterolemia, severe anemia, and normal serum albumin. Testing of antineutrophil cytoplasmic antibodies anti-myeloperoxidase was positive at a titer of 1/80. Serum and urine protein electrophoresis and other exams showed no alterations. She was started on steroid pulse therapy after worsening kidney function, reaching serum creatinine of 3.3 mg/dL. A kidney biopsy revealed crescentic glomerulonephritis with glomerular sclerosis, fibrous crescents, interstitial fibrosis, and tubular atrophy. Induction therapy was given with intravenous cyclophosphamide 0.5 g/m2 for 6-monthly pulses, followed by maintenance therapy with oral azathioprine at 2 mg/kg and prednisone tapering. The patient did not develop any complications during the induction therapy, and is currently on maintenance therapy with a serum creatinine of 1.87 mg/dL.

New-Onset Rheumatic Immune-Mediated Inflammatory Diseases Following SARS-CoV-2 Vaccinations until May 2023: A Systematic Review

“…The three most common small vessel vasculitis were ANCA-associated vasculitis (AAV) (33/64, 51%), cutaneous vasculitis (22/64, 34%), and Henoch-Schoenlein purpura (HSP) (5/64, 7%). Out of AAV patients, the majority (20) had positive Myeloperoxidase Antibody (MPO) ANCA with titres ranging from 1.1 units/mL to 3500 units/mL [41][42][43][44][45][46]48,96,116,122,124,128,137,150,160,168,178,182,183,187], and nine were proteinase-3 (PR3) ANCA positive, ranging from 6.7 units to 259 units. Of AAV, 24/30 patients developed biopsy-proven crescentic glomerulonephritis [38,41,42,45,46,48,51,52,55,96,116,122,124,128,130,136,137,150,157,160,168,178,182,187].…”

“…Out of AAV patients, the majority (20) had positive Myeloperoxidase Antibody (MPO) ANCA with titres ranging from 1.1 units/mL to 3500 units/mL [41][42][43][44][45][46]48,96,116,122,124,128,137,150,160,168,178,182,183,187], and nine were proteinase-3 (PR3) ANCA positive, ranging from 6.7 units to 259 units. Of AAV, 24/30 patients developed biopsy-proven crescentic glomerulonephritis [38,41,42,45,46,48,51,52,55,96,116,122,124,128,130,136,137,150,157,160,168,178,182,187]. Six had pulmonary and renal syndrome [45,55,137,...…”

“…She had positive ANA, a Coombs test, and thrombocytopaenia. The patient was diagnosed with SLE and Evans syndrome and was successfully treated with oral corticosteroids [128]. Another 23-year-old female with no medical history developed facial and limb oedema and anasarca a week after receiving the SARS-CoV-2 vaccination.…”

ANCA-associated glomerulonephritis and lupus nephritis following COVID-19 vaccination: a case report and literature review

“… *Including the present case. References: a ( 23 – 47 ); b ( 48 – 52 ); c ( 47 , 48 , 53 – 61 ); d ( 47 , 56 , 62 – 68 ); e ( 48 , 69 ); f ( 47 – 49 , 70 ); g ( 47 , 48 , 53 , 71 – 85 ); h ( 2 , 86 , 87 ). …”

ANCA Associated Glomerulonephritis Following SARS-CoV-2 Vaccination: A Case Series and Systematic Review

“…The following supporting information can be downloaded at: , Table S1: Clinical spectrums and outcomes of ANCA-associated glomerulonephritis following SARS-CoV-2 vaccination. Refs [ 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 ] mentioned in Supplementary Materials.…”