Relapse of microscopic polyangiitis after vaccination against COVID‐19: A case report

Conticini, Edoardo; d’Alessandro, Miriana; Bergantini, Laura; Bargagli, Elena; Gentili, Francesco; Mazzei, Maria Antonietta; Cantarini, Luca; Frediani, Bruno

doi:10.1002/jmv.27192

Cited by 14 publications

(10 citation statements)

References 14 publications

(19 reference statements)

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“…27 Although rare, relapse of AAVafter COVID-19 vaccination has been reported in the literature. 49,50 The overall risks of severe adverse events continue to remain low in patients with RDs. Clinicians should monitor such patients closely upon receiving SARS-CoV-2 vaccination.…”

Section: Discussionmentioning

confidence: 99%

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Immunogenicity and Safety of SARS-CoV-2 Vaccination in Patients With Rheumatic Diseases: A Systematic Review and Meta-analysis

Sood¹,

Tran²,

Murthy

et al. 2022

J Clin Rheumatol

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Background: Patients with rheumatic disease (RD) are at increased risk for COVID-19 infection. Large clinical trials have demonstrated efficacy and safety of SARS-CoV-2 vaccine. However, patients with RD are typically excluded from these trials. Objective:The aim of this study was to conduct a systematic review and meta-analysis examining the immunogenicity and safety of SARS-CoV-2 vaccination in patients with RD. Methods:We systematically searched PubMed/MEDLINE and Scopus to identify observational studies that examined the immunogenicity and safety of SARS-CoV-2 vaccination in RD patients. Information on disease, immunosuppressant, vaccine type, and proportion of patients with serologic response was obtained from each study.Results: There were 25 eligible studies. The pooled rate of seroconversion was 0.79 (95% confidence interval [CI], 0.72-0.86). Compared with control subjects, the odds of seroconversion were significantly lower (odds ratio, 0.11; 95% CI, 0.05-0.24). Users of rituximab showed the lowest rate of seroconversion (0.39; 95% CI, 0.29-0.51) followed by mycophenolate (0.56; 95% CI, 0.40-71). On the other hand, users of interleukin 17 (0.94; 95% CI, 0.78-0.98) and tumor necrosis factor inhibitors (0.94; 95% CI, 0.84-0.98) showed high seroconversion rate. Regarding safety of COVID-19 vaccine, approximately 2% of patients reported severe adverse events and 7% reported diseases flares following the first or second dose. Conclusion:Vaccination against SARS-CoV-2 appears to be safe. Most RD patients developed humoral immune response following vaccination. However, the odds of seroconversion were significantly lower in RD patients compared with controls. This is likely driven by certain immunosuppressants including rituximab and mycophenolate. Future studies need to identify strategies to improve vaccine response in these patients.

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Section: Discussionmentioning

confidence: 99%

“…Two weeks following the second dose, the patient underwent fulminant hemorrhagic cutaneous vasculitis complicated by sepsis 27 . Although rare, relapse of AAV after COVID-19 vaccination has been reported in the literature 49,50 . The overall risks of severe adverse events continue to remain low in patients with RDs.…”

Section: Discussionmentioning

confidence: 99%

Immunogenicity and Safety of SARS-CoV-2 Vaccination in Patients With Rheumatic Diseases: A Systematic Review and Meta-analysis

Sood¹,

Tran²,

Murthy

et al. 2022

J Clin Rheumatol

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“…The very first evidence came from case reports or small case series, reporting the onset of autoimmune inflammatory disorders in previously healthy subjects or their relapse in patients considered in remission or in low disease activity [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Relapses of idiopathic inflammatory myopathies after vaccination against COVID-19: a real-life multicenter Italian study

et al. 2022

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Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccination plays a crucial role as pivotal strategy to curb the coronavirus disease-19 (COVID-19) pandemic. The present study described the clinical status of patients affected by idiopathic inflammatory myopathies (IIM) after COVID-19 vaccination to assess the number of relapses. We included all patients affected by IIM and followed by Myositis Clinic, Rheumatology and Respiratory Diseases Units, Siena University Hospital, Bari University Hospital, Policlinico Umberto I, Sapienza University, Rome, and Policlinico Paolo Giaccone, Palermo. They underwent a telephone survey. A total of 119 IIM patients (median, IQR 58 (47–66) years; 32males; 50 dermatomyositis, 39 polymyositis and 30 anti-synthetase syndrome) were consecutively enrolled. Except four patients who refused the vaccination, 94 (81.7%) received Comirnaty, 16 (13.9%) Spikevax, 5 (4.4%) Vaxzevria. Seven (6.1%) patients had flare after vaccination. One of them had life-threatening systemic involvement and died two months after second dose of COVID-19 vaccination. From logistic regression analysis, Chi2-log ratio = 0.045,the variable that most influences the development of flare was the number of organs involved (p = 0.047). Sixty-eight patients received the third dose of COVID-19 vaccination: 51(75%) Comirnaty and 17 (25%) Moderna. No patients had flares after third dose. Our study represents the largest cohort of IIM patients in which the incidence of recurrence after anti-SARS-CoV-2 vaccine was assessed. In line with real-life data from other diseases, we found a clinical non-statistically significant risk of relapse in our patients, which occurred seldom, usually mild and in patients with a more severe and aggressive course of disease.

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“…It has been suggested that portal infiltration with eosinophils correlates with drug-induced liver injury, including vaccines (i.e., Moderna mRNA-1273 and AstraZeneca ChAdOx1 nCoV-19 vaccines) [ 8 , 27 , 28 ]. This could partially explain the existence of hepatitis following vaccination without positivity for liver-associated autoantibodies ( Table 1 ) [ 8 , 10 , 12 , 13 , [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] ].…”

Section: Discussionmentioning

confidence: 99%

“… Aldolase raise (10,3 U/L NV < 7.6) ANAS 1:160, borderline positivity Anti-Pm/scl-75 antibodies Electromyography: moderate severity subacute myositis without muscle damage and polyneuropathy. Conticini et al [ 44 ] Relapse of microscopic polyangiitis Pfizer- BioNTech mRNA vaccine Few days after 1 dose Arterial blood pO2 48 mm Hg) CRP 3.7 mg/dL, creatinine 1.55 mg/dL Negative autoimmunity blood tests High‐resolution computed tomography: diffuse “ground‐glass” opacities with superimposed septal thickening and subpleural consolidations Sauret et al [ 13 ] Giant Cell Arteritis AstraZeneca ChAdOx1 nCoV-19 vaccine Few days after 1 dose GGT 112 U/L, ALP 40 U/L Authors did not performed autoantibodies Ishay et al [ 10 ] Pfizer- BioNTech mRNA vaccine Case 1: 3 days after 1 dose Case 1: Negative ANAs, RF, and anti-CCP antibodies Case 1: Symmetric polyarthritis Case 2: 10 days after 1 dose Case 2: No autoantibodies Case 2: Exacerbation of Beçet disease Case 3: 1 day after 1 dose Case 3: No autoantibodies Case 3: Pericarditis Case 4: 3 days after 1 dose Case 4: No autoantibodies Case 4: Termporal arteritis like disease Case 5: Few hours after 1 dose Case 5: No autoantibodies Case 5: <...>…”

Section: Discussionmentioning

confidence: 99%

COVID-19 vaccine and autoimmunity. A new case of autoimmune hepatitis and review of the literature

Camacho-Domínguez

Rodríguez

Polo

et al. 2022

Journal of Translational Autoimmunity

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Autoimmunity following COVID-19 vaccination has been reported. Herein, a 79-year-old man with clinical and immunological features of autoimmune hepatitis type 1 after ChAdOx1 nCoV-19 vaccination is presented. Clinical manifestations rapidly remitted after the instauration of immunomodulatory management. This case, together with a comprehensive review of the literature, illustrates the association between COVID-19 vaccines and the development of autoimmune conditions.

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Relapse of microscopic polyangiitis after vaccination against COVID‐19: A case report

Cited by 14 publications

References 14 publications

Immunogenicity and Safety of SARS-CoV-2 Vaccination in Patients With Rheumatic Diseases: A Systematic Review and Meta-analysis

Immunogenicity and Safety of SARS-CoV-2 Vaccination in Patients With Rheumatic Diseases: A Systematic Review and Meta-analysis

Relapses of idiopathic inflammatory myopathies after vaccination against COVID-19: a real-life multicenter Italian study

COVID-19 vaccine and autoimmunity. A new case of autoimmune hepatitis and review of the literature

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