A case of ANCA-associated vasculitis after AZD1222 (Oxford–AstraZeneca) SARS-CoV-2 vaccination: casualty or causality?

Villa, Miguel; Díaz-Crespo, Francisco; José, Ana Pérez de; Verdalles, Úrsula; Verde, Eduardo; Ruiz, Fernando A. Rojas; Acosta, Adriana; Mijaylova, Antonia; Goicoechea, Marián

doi:10.1016/j.kint.2021.07.026

Cited by 52 publications

(35 citation statements)

References 4 publications

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“…Prior cases have been mainly reported among elderly individuals without known renal diseases. Six cases have been associated with a mRNA vaccine, while a viral vector vaccine has been associated with two cases (8)(9)(10)(11)(12)(13)(14). AAV was diagnosed after either the first dose (37.5%) or second dose (62.5%) of COVID-19 vaccination.…”

Section: Discussionmentioning

confidence: 99%

“…AAV was diagnosed after either the first dose (37.5%) or second dose (62.5%) of COVID-19 vaccination. The onset time of symptoms varied from <1 week to 7 weeks (8)(9)(10)(11)(12)(13)(14). While non-specific prodromal symptoms were observed after vaccination, characteristic findings included microscopic or gross hematuria with dysmorphic red blood cells, significant proteinuria, and acute renal failure (8)(9)(10)(11)(12)(13)(14).…”

Section: Discussionmentioning

confidence: 99%

“…The onset time of symptoms varied from <1 week to 7 weeks (8)(9)(10)(11)(12)(13)(14). While non-specific prodromal symptoms were observed after vaccination, characteristic findings included microscopic or gross hematuria with dysmorphic red blood cells, significant proteinuria, and acute renal failure (8)(9)(10)(11)(12)(13)(14). Serum creatinine levels ranged from 1.9 to 8.4 mg/dL (8,(10)(11)(12)(13)(14).…”

Section: Discussionmentioning

confidence: 99%

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Case Report: Anti-neutrophil Cytoplasmic Antibody-Associated Vasculitis With Acute Renal Failure and Pulmonary Hemorrhage May Occur After COVID-19 Vaccination

Chen

et al. 2021

Front. Med.

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The rare and severe adverse effects associated with coronavirus disease of 2019 (COVID-19) vaccination have been under-appreciated, resulting in many instances of inappropriate management. We describe the case of an elderly woman who developed anti-neutrophil cytoplasmic antibody-associated vasculitis with pulmonary renal syndrome approximately 3 weeks after the first dose of COVID-19 mRNA vaccination (Moderna). Her nasopharyngeal polymerase chain reaction test for the COVID-19 RNA virus was negative. Gross hematuria, heavy proteinuria, acute renal failure (serum creatinine up to 6.5 mg/dL), and hemoptysis coupled with a marked increase in serum anti-myeloperoxidase-O antibody were observed. Renal biopsy showed severe vasculitis with pauci-immune crescent glomerulonephritis. The pulmonary hemorrhage was resolved and renal function improved following combined plasma exchange and the administration of systemic steroids and anti-CD20 therapy. The early examination of urinalysis and renal function may be crucial for identifying glomerulonephritis and acute renal failure in susceptible patients after COVID-19 vaccination.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Case Report: Anti-neutrophil Cytoplasmic Antibody-Associated Vasculitis With Acute Renal Failure and Pulmonary Hemorrhage May Occur After COVID-19 Vaccination

Chen

et al. 2021

Front. Med.

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“…36 articles were identified including a total of 49 reported cases (Table 1). These included MCD (n = 17) (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), IgA nephropathy (IgAN) (n = 15) (26)(27)(28)(29)(30)(31)(32)(33)(34), IgA nephritis/vasculitis (n = 5) (10,30,35,36), ANCA glomerulonephritis/vasculitis (n = 5) (7,8,35,37,38), anti-GBM nephritis (n = 2) (28, 39), 1 case of each granulomatous vasculitis (40), acute tubulointerstitial nephritis (ATIN) (41), scleroderma renal crisis (42), IgG4-related disease nephritis (43), and primary MN (11).…”

Section: Methods and Resultsmentioning

confidence: 99%

“…To our knowledge, to date, there have been 5 reports of ANCA vasculitis following COVID-19 vaccinations (2 after Moderna, 2 after Pfizer-BioNTech, and 1 after Oxford-AstraZeneca) (7,8,35,37,38).…”

Section: Anca Glomerulonephritis/vasculitismentioning

confidence: 99%

Kidney complications following COVID-19 vaccination; a review of the literature

Hassanzadeh¹,

Djamali

Mostafavi

et al. 2021

J Nephropharmacol

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Objective: To review the reported cases of kidney injury following vaccination for coronavirus disease 2019 (COVID-19) with a focus on renal pathology. Methods: We searched for case reports of kidney complications after COVID-19 vaccine in PubMed. Results: A total of 36 articles including 49 case reports were reported. These included minimal change disease (n=17), IgA nephropathy (IgAN) (n=15), IgA nephritis/vasculitis (n=5), ANCA glomerulonephritis/vasculitis (n=5), anti-glomerular basement membrane (GBM) nephritis (n=2), and 1 case of each granulomatous vasculitis, acute tubulointerstitial nephritis, scleroderma renal crisis, IgG4-related disease nephritis, and primary membranous nephropathy (MN). Conclusion: We give an overview of the reported cases of post-COVID-19 renal complications. Further investigations of the underlying pathogenesis of post-COVID-19 vaccination renal adverse events are required, as prompt workup, diagnosis, and treatment of patients with renal complications may lead to complete remission, prevent kidney failure, and long-term complications such as end-stage renal disease (ESRD). However, these complications are overall extremely rare and the benefit of vaccination outweighs the potential risks.

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COVID-19 Vasculitis and vasculopathy-Distinct immunopathology emerging from the close juxtaposition of Type II Pneumocytes and Pulmonary Endothelial Cells

et al. 2022

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The SARS-CoV-2 virus ACE-2 receptor utilization for cellular entry and the defined ACE-2 receptor role in cardiovascular medicine hinted at dysregulated endothelial function or even direct viral endotheliitis as the key driver of severe COVID-19 vascular immunopathology including reports of vasculitis. In this article, we critically review COVID-19 immunopathology from the vasculitis perspective and highlight the non-infectious nature of vascular endothelial involvement in severe COVID-19. Whilst COVID-19 lung disease pathological changes included juxta-capillary and vascular macrophage and lymphocytic infiltration typical of vasculitis, we review the evidence reflecting that such “vasculitis” reflects an extension of pneumonic inflammatory pathology to encompass these thin-walled vessels. Definitive, extrapulmonary clinically discernible vasculitis including cutaneous and cardiac vasculitis also emerged- namely a dysregulated interferon expression or “COVID toes” and an ill-defined systemic Kawasaki-like disease. These two latter genuine vasculitis pathologies were not associated with severe COVID-19 pneumonia. This was distinct from cutaneous vasculitis in severe COVID-19 that demonstrated pauci-immune infiltrates and prominent immunothrombosis that appears to represent a novel immunothrombotic vasculitis mimic contributed to by RNAaemia or potentially diffuse pulmonary venous tree thrombosis with systemic embolization with small arteriolar territory occlusion, although the latter remains unproven. Herein, we also performed a systematic literature review of COVID-19 vasculitis and reports of post-SARS-CoV-2 vaccination related vasculitis with respect to the commonly classified pre-COVID vasculitis groupings. Across the vasculitis spectrum, we noted that Goodpasture’s syndrome was rarely linked to natural SARS-CoV-2 infection but not vaccines. Both the genuine vasculitis in the COVID-19 era and the proposed vasculitis mimic should advance the understanding of both pulmonary and systemic vascular immunopathology.

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A case of ANCA-associated vasculitis after AZD1222 (Oxford–AstraZeneca) SARS-CoV-2 vaccination: casualty or causality?

Cited by 52 publications

References 4 publications

Case Report: Anti-neutrophil Cytoplasmic Antibody-Associated Vasculitis With Acute Renal Failure and Pulmonary Hemorrhage May Occur After COVID-19 Vaccination

Case Report: Anti-neutrophil Cytoplasmic Antibody-Associated Vasculitis With Acute Renal Failure and Pulmonary Hemorrhage May Occur After COVID-19 Vaccination

Kidney complications following COVID-19 vaccination; a review of the literature

COVID-19 Vasculitis and vasculopathy-Distinct immunopathology emerging from the close juxtaposition of Type II Pneumocytes and Pulmonary Endothelial Cells

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