Microscopic Polyangiitis Following mRNA COVID-19 Vaccination: A Case Report

Abstract

Coronavirus disease 2019 (COVID-19) is one of the most widespread viral infections in human history. As a breakthrough against infection, vaccines have been developed to achieve herd immunity. Here, we report the first case of microscopic polyangiitis (MPA) following BNT162b2 vaccination in Korea. A 42-year-old man presented to the emergency room with general weakness, dyspnea, and edema after the second BNT162b2 vaccination. He had no medical history other than being treated for tuberculosis last year. Although his renal function was normal at last year, acute kidney injury was confirmed at the time of admission to the emergency room. His serum creatinine was 3.05 mg/dL. Routine urinalysis revealed proteinuria (3+) and hematuria. When additional tests were performed for suspected glomerulonephritis, the elevation of myeloperoxidase (MPO) antibody (38.6 IU/mL) was confirmed. Renal biopsy confirmed pauci-immune anti-neutrophil cytoplasmic antibody (ANCA)-related glomerulonephritis and MPA was diagnosed finally. As an induction therapy, a combination of glucocorticoid and rituximab was administered, and plasmapheresis was performed twice. He was discharged after the induction therapy and admitted to the outpatient clinic 34 days after induction therapy. During outpatient examination, his renal function had improved with serum creatinine 1.51 mg/dL. We suggest that MPA needs to be considered if patients have acute kidney injury, proteinuria, and hematuria after vaccination.

Longitudinal Analysis of Antiphospholipid Antibody Dynamics after Infection with SARS-CoV-2 or Vaccination with BNT162b2

“…These results should be interpreted with caution as a meta-analysis published later found no association between HPV vaccination and autoimmunity [45]. There are a few recent studies, mostly case-control studies, reporting induction of various autoimmune diseases in individuals after vaccination with BNT162b2, including rheumatoid arthritis [46], ANCA-associated vasculitis [47,48], and microscopic polyangiitis [49].…”

Insights into new-onset autoimmune diseases after COVID-19 vaccination

“…Elevated MPO antibodies and histological findings lead to the diagnosis of MPA. After receiving glucocorticoid therapy, rituximab, and plasma exchange, the patient’s symptoms improved [ 129 ]. However, the exact mechanism by which COVID-19 vaccines induce AAV is not yet well understood.…”

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

“…These authors also observed the reduction of the ANCA response to the RNA vaccine once it was treated with ribonuclease. ANCA vasculitis has been reported in connection with COVID-19 infection and the different types of vaccination to prevent it [2][3][4][5][6]17,18], prompting the suspicion of whether the immunological phenomenon is a direct result of the mRNA content of the vaccine. Hypothesized mechanisms like molecular mimicry, defective neutrophilic apoptosis, polyclonal activation, and a systemic proinflammatory cytokine response can explain the temporal causal association between autoimmune manifestations of ANCA vasculitis and COVID-19 vaccines.…”

“…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].…”

“…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]. MPA is a systemic necrotizing small-vessel vasculitis that predominantly affects the pulmonary and renal systems.…”