<i>De novo</i> and relapsing necrotizing vasculitis after COVID-19 vaccination

Fillon, Alexandre; Sautenet, Bénédicte; Barbet, Christelle; Moret, Léa; Thillard, Eve Marie; Jonville-Béra, Annie Pierre; Halimi, Jean Michel

doi:10.1093/ckj/sfab285

Cited by 22 publications

(15 citation statements)

References 14 publications

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“…Whether or not booster vaccination affects the development of vasculitis is unclear at present. Further prospective studies are thus warranted to investigate the There have been only three cases of medium vesselvasculitis following COVID-19 vaccination (including our case) reported thus far (Table) (6,7). The median age was 46 years old, and 2 patients were men.…”

Section: Discussionmentioning

confidence: 81%

“…COVID-19 vaccines were associated with an increasing risk of GCA (reported reaction 2.7, 95% confidence interval: 2.3, 3.2) (27). Among patients with GCA following COVID-19 vaccination, most developed GCA after the first dose of the vaccine, and the median time to reaction was 2.5 days, which differed from the course with medium-vessel vasculitis (6,7,27).…”

Section: Discussionmentioning

confidence: 87%

“…Several investigators have reported small-vessel vasculitis following COVID-19 vaccination, including anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) ( 4 , 5 ). However, only a few have reported medium-vessel vasculitis following vaccination ( 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

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Medium-vessel Vasculitis Presenting with Myalgia Following COVID-19 Moderna Vaccination

et al. 2022

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Coronavirus disease 2019 (COVID-19) vaccines have been delivered worldwide to prevent the spread of the disease, and almost all Japanese have received the mRNA vaccines "BNT162b2" (Pfizer-Biotech) or "mRNA-1273" (Moderna). These vaccines have shown efficacy and safety with only minor adverse drug reactions. However, some patients develop severe adverse drug reactions, including autoimmune reactions. In addition, systemic vasculitis, mainly small-vessel vasculitis, following COVID-19 vaccination, has been reported. However, only a few investigators have reported medium-vessel vasculitis following vaccination. We herein report a case of medium-vessel vasculitis presenting with myalgia as the initial clinical manifestation following COVID-19 Moderna vaccination.

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 87%

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Medium-vessel Vasculitis Presenting with Myalgia Following COVID-19 Moderna Vaccination

et al. 2022

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“…Our patient instead maintained a normal kidney function, creatinine kinase levels were in range, and clinical examination did not find suspicious skin manifestations; it was not necessary to administer specific treatments apart from Levamisole discontinuation. Moreover, in the published case reports, only MPO antibody titers were elevated, and the mean delay between vaccination and the first symptoms was 27 days [ 22 , 23 , 24 ]. Conversely, drug-induced vasculitis is associated with increased levels of both of these antibodies in the literature.…”

Section: Discussionmentioning

confidence: 99%

Late Onset of ANCA Vasculitis as a Side Effect of Levamisole Treatment in Nephrotic Syndrome

et al. 2022

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Levamisole is effectively used in steroid-dependent nephrotic syndrome and the more frequent side effects reported are cytopenia and liver enzymes alterations. Several studies have demonstrated that this drug can induce high titers of circulating perinuclear antineutrophil cytoplasmic autoantibodies (ANCA) and vasculitis, most of them occurring in the case of prolonged use. A four-year-old boy that was affected with steroid-dependent nephrotic syndrome was treated with Levamisole as a steroid-sparing agent at a dose of 2 mg/kg/48 h. After initiation of the treatment, the number of relapses drastically decreased, enabling a significant reduction in the cumulative steroid dose. Levamisole was well tolerated, and was therefore administered for several years. At the age of 15, he was also diagnosed with celiac disease. After nine years of continuous Levamisole treatment, he presented with a high fever, hand and foot joint arthritis, and increased levels of total and direct bilirubin. Since the symptoms started two days after the injection of the second dose of the COVID-19 vaccine, it was initially concluded that these manifestations were rare vaccination side effects. Therefore, he did not receive any specific treatments, and Levamisole was continued at the same dose. After an initial improvement, two months later, the patient presented with the same symptoms. Suspecting Levamisole-induced vasculitis, an ANCA titer was measured and this returned positive. Clinical manifestations and double positivity for both myeloperoxidase (MPO) and anti-proteinase 3 (PR3) antibodies argued against the fact that that these findings were secondary to vaccination, cocaine abuse, or celiac disease. Assuming that we were facing a rare drug reaction, Levamisole was promptly interrupted. This resulted in a rapid remission of fever and arthritis improvement, and a decrease in ANCA titers. By reporting this case, we want to raise awareness among clinicians regarding a rare complication of treatment with Levamisole that is often misdiagnosed due to the fact that the current literature lacks univocal guidelines regarding the precise timing of ANCA titrations and the duration of the treatment.

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“…Published results of the phase 3 clinical trials described only a few severe side effects [ 2 , 6 , 7 , 8 ]. However, it has since become clear that severe and even fatal adverse events may occur; these include in particular cardiovascular and neurological manifestations [ 9 , 10 , 11 , 12 , 13 ]. Clinicians should take note of such case reports for the sake of early detection and management of such adverse events among their patients.…”

Section: Introductionmentioning

confidence: 99%

A Case Report: Multifocal Necrotizing Encephalitis and Myocarditis after BNT162b2 mRNA Vaccination against COVID-19

Mörz

2022

Vaccines

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The current report presents the case of a 76-year-old man with Parkinson’s disease (PD) who died three weeks after receiving his third COVID-19 vaccination. The patient was first vaccinated in May 2021 with the ChAdOx1 nCov-19 vector vaccine, followed by two doses of the BNT162b2 mRNA vaccine in July and December 2021. The family of the deceased requested an autopsy due to ambiguous clinical signs before death. PD was confirmed by post-mortem examinations. Furthermore, signs of aspiration pneumonia and systemic arteriosclerosis were evident. However, histopathological analyses of the brain uncovered previously unsuspected findings, including acute vasculitis (predominantly lymphocytic) as well as multifocal necrotizing encephalitis of unknown etiology with pronounced inflammation including glial and lymphocytic reaction. In the heart, signs of chronic cardiomyopathy as well as mild acute lympho-histiocytic myocarditis and vasculitis were present. Although there was no history of COVID-19 for this patient, immunohistochemistry for SARS-CoV-2 antigens (spike and nucleocapsid proteins) was performed. Surprisingly, only spike protein but no nucleocapsid protein could be detected within the foci of inflammation in both the brain and the heart, particularly in the endothelial cells of small blood vessels. Since no nucleocapsid protein could be detected, the presence of spike protein must be ascribed to vaccination rather than to viral infection. The findings corroborate previous reports of encephalitis and myocarditis caused by gene-based COVID-19 vaccines.

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De novo and relapsing necrotizing vasculitis after COVID-19 vaccination

Cited by 22 publications

References 14 publications

Medium-vessel Vasculitis Presenting with Myalgia Following COVID-19 Moderna Vaccination

Medium-vessel Vasculitis Presenting with Myalgia Following COVID-19 Moderna Vaccination

Late Onset of ANCA Vasculitis as a Side Effect of Levamisole Treatment in Nephrotic Syndrome

A Case Report: Multifocal Necrotizing Encephalitis and Myocarditis after BNT162b2 mRNA Vaccination against COVID-19

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