‘Granulomatosis with polyangiitis after Pfizer vaccination’: a case report

Abstract

The advent of COVID-19, caused by the SARS-CoV-2 virus, has resulted in over 541 million cases with 6.32 million deaths worldwide as of June 2022. The devastating consequences of this global pandemic resulted in the expedited generation of mRNA-based vaccines such as the Pfizer-BioNTech and Moderna vaccines. Although the vaccines have been effective, with recent data indicating greater than 95% effectiveness, rare complications have been reported, including manifestations of autoimmune phenomena. Herein, we report a rare case of Granulomatosis with polyangiitis (GPA) in an active duty military male soon after receiving the first dose of the Pfizer-BioNTech COVID-19 vaccine. Plain Language Summary A 27-year-old active duty marine was admitted to our hospital after being transferred from Hawaii with concern of new autoimmune disease after receiving the Pfizer vaccine. The patient initially presented to the emergency department with joint pain, fever, chest pain, hemoptysis, and a nose bleed. A comprehensive workup demonstrated elevated inflammatory markers, progressive renal dysfunction, and a positive antibody panel consistent with antineutrophil cytoplasmic antibodies (ANCA) vasculitis. Due to the limited capabilities in his deployed setting, he was transferred to our hospital for a higher level of care. We performed some additional tests to include computed tomography (CT) imaging of his lungs and a renal biopsy which came back consistent with GPA. The patient was started on high-dose prednisone and rituximab, and he achieved remission. He was discharged from the hospital with follow-up arranged with rheumatology and nephrology. He remained in remission on follow-up.

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

“…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,...…”

“…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 [45,55,137,157,160,178], whereas three patients had only lung involvement with pulmonary haemorrhage or multi-focal consolidations [43,109]. Two patients were positive for both PR3 and MPO-ANCA [43,44].…”

Pulmonary Artery Aneurysm Associated With Aspergilloma in a Patient Diagnosed With Granulomatosis With Polyangiitis

“…It commonly involves the upper respiratory tract, lungs, and kidneys, with isolated sinonasal disease present in 25% of cases [ 3 ]. GPA belongs to a group of ANCA vasculitis, which also includes eosinophilic granulomatosis with polyangiitis and microscopic polyangiitis [ 4 ]. Although the exact cause of GPA is not known, a complex interaction involving genetics, environmental factors, and microbiomes has been implicated in the pathogenesis, with ANCA presumed to be responsible for inflammation [ 1 , 4 ].…”

“…GPA belongs to a group of ANCA vasculitis, which also includes eosinophilic granulomatosis with polyangiitis and microscopic polyangiitis [ 4 ]. Although the exact cause of GPA is not known, a complex interaction involving genetics, environmental factors, and microbiomes has been implicated in the pathogenesis, with ANCA presumed to be responsible for inflammation [ 1 , 4 ]. The diagnosis can be made according to the American College of Rheumatology criteria or the ELK (E stands for ear, nose, and throat or upper respiratory tract, L for lung, and K for kidney) criteria [ 1 ].…”

Cardiac Tamponade as a Complication of Microscopic Polyangiitis: A Case Associated With a COVID-19 mRNA Vaccine

“…As vaccination rates increase, rare side effects begin to emerge. Cases of small-vessel vasculitis have been reported following the administration of the different COVID-19 vaccines [2][3][4][5][6][7][8][9][10]. Only a few instances of microscopic polyangiitis (MPA) following Pfizer-BioNTech mRNA vaccine administration have been reported in English literature [2][3][4][5][6].…”