De-Novo Antineutrophil Cytoplasmic Antibody-Associated Vasculitis Following the mRNA-1273 (Moderna) Vaccine for COVID-19

Abstract

Antineutrophil cytoplasmic antibody (ANCA) is a systemic autoimmune disorder characterized by antibodies directed against small- and moderate-sized vessels. While there are few reported cases of autoimmune illnesses associated with influenza vaccination, two cases of de-novo anti-proteinase (PR3) ANCA-associated pauci immune glomerulonephritis are reported after the mRNA-1273 coronavirus disease 2019 (COVID-19) vaccine. Here, we report the third case of ANCA-associated glomerulonephritis after the mRNA-1273 COVID-19 vaccine. Our patient presented with acute kidney injury and sub-nephrotic proteinuria four days after receiving the second dose of the COVID vaccine. He was found to have elevated c-ANCA and anti-PR3 antibodies. Renal biopsy confirmed focal necrotizing and diffuse crescentic glomerulonephritis. He was diagnosed with pauci immune glomerulonephritis. The patient achieved remission 10 weeks after the diagnosis with successful treatment.

A Case of Antineutrophil Cytoplasmic Antibodies (ANCA)-Associated Vasculitis Post COVID-19 Vaccination

“…Since the COVID-19 vaccination initiative began in December 2020, few cases of COVID-19 vaccine-associated AAV have been reported. Three cases of MPO-ANCA [6][7][8] and three cases of PR3-ANCA-associated AAV [5,9,10] post COVID-19 vaccination have been described. Interestingly, most of these cases described only renal limited disease manifestations instead of a systemic clinical picture as appears to be described here.…”

“…The associated small vessel vasculitis pathologies include granulomatosis with polyangiitis (GPA), eosinophilic granulomatosis with polyangiitis, and microscopic polyangiitis [ 2 , 3 ]. There have been reports of an association of developing new-onset AAV following the Influenza vaccine [ 4 ] and COVID-19 vaccines [ 5 ]. In this report, we discuss a case of AAV manifesting after receiving the COVID-19 vaccine.…”

New-Onset Acute Kidney Disease Post COVID-19 Vaccination

“…As of 28 February 2022, we found a total of 38 published articles (53 cases) on AKI after SARS-CoV-2 vaccination ( Table 1 ) [ 11 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ]. Only one case clearly identified an increase in Scr and a resolve within 7 days after vaccination [ 30 ].…”

Overview of infections as an etiologic factor and complication in patients with vasculitides

“…Further research in this field is required, however, to better define the pathophysiologic basis of autoimmune diseases incidence in COVID-19 [61]. It should also be stated that vaccination against SARS-CoV-2 may also be complicated with cutaneous vasculitic phenomena or even IgA vasculitis and AAV [62][63][64][65][66].…”