A Case Report of MPO-ANCA-Associated Vasculitis Following Heterologous mRNA1273 COVID-19 Booster Vaccination

Abstract

Despite that clinical trials have been examining the safety profile of coronavirus disease 2019 (COVID-19) vaccines, there are concerns about long-term side effects as the number of vaccinations increases. Herein, we report a case of new-onset renal-limited anti-myeloperoxidase (MPO) antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis after booster vaccination with the mRNA 1273 (Moderna) vaccine. A 72-year-old woman with no specific past history, and who had a normal renal function, developed ANCA-associated vasculitis following heterologous booster with mRNA1273 (Moderna) vaccine. After a kidney biopsy, she was diagnosed with ANCA-associated pauci-immune crescentic glomerulonephritis. Her renal function and constitutional symptoms have been improved with treatment with plasmapheresis, intravenous cyclophosphamide and steroid pulse therapy (intravenous 500 mg of methylprednisolone sodium succinate for 3 days) followed by a reduced steroid regimen.

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

“…Based on renal biopsy results, ANCA-associated pauci-immune crescentic glomerulonephritis was diagnosed. After high-dose steroid treatment and plasmapheresis, the patient’s symptoms and renal function improved [ 83 ].…”

“…AAV is classified into three types based on clinical features, namely granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic GPA (EGPA) [ 111 ]. A total of 17 new-onset AAV cases have been reported, including 5 cases of PR3-ANCA vasculitis, 9 cases of MPO-ANCA vasculitis, and 3 cases of dual-positive MPO- and PR3-ANCA vasculitis [ [112] , [113] , [114] , [115] , [116] , [117] , [118] , [119] , [120] , [121] , [122] , [123] , [124] , [125] , [126] , [127] , [128] ]. The majority of cases were women (11/17, 64.7%).…”

ANCA-Associated Vasculitis after Moderna COVID-19 Vaccination

“…Tese fndings are consistent with existing reports. Tere is also a report of ANCA-associated [18]. A recent comparative study on using the same vaccine as the primary series (homologous boosters) versus using a diferent vaccine (heterologous boosters) showed that the immunogenicity of heterologous boosting was generally similar to or greater than those of homogenous boosting [19].…”

Short-Term Effect of SARS-CoV-2 Spike Protein Receptor-Binding Domain-Specific Antibody Induction on Neutrophil-Mediated Immune Response in Mice

“…The data provided in the present study demonstrate that RBD-specific antibody induction suppresses NET formation, supporting the preventive effects of vaccination in the case of vascular complications. Unfortunately, a number of case reports demonstrate that neutrophil-associated complications and vasculitis can be triggered by vaccination [ 45 , 46 ]. Enhanced pathogen-induced neutrophil recruitment in the case of RBD-specific antibody induction observed in the present study can in part explain the adverse reactions to vaccination.…”