ANCA-associated vasculitis following ChAdOx1 nCoV19 vaccination: case-based review

Abstract

For the foreseeable future, vaccines are the cornerstone in the global campaign against the Coronavirus Disease-19 (COVID-19) pandemic. As the number and fatalities due to COVID-19 decline and the lockdown anywise rescinded, we recognize an increase in the incidence of autoimmune disease post-COVID-19 vaccination. However, the causality of the most vaccine-induced side effects is debatable and, at best, limited to a temporal correlation. We herein report a case of a 51-year-old gentleman who developed Anti-Neutrophil Cytoplasmic Antibody (ANCA)-associated vasculitis (AAV) 2 week post-COVID-19 vaccination. The patient responded favorably to oral steroids and rituximab. Additionally, we conducted a case-based review of vaccine-associated AAV describing their clinical manifestations and treatment response of this emerging entity. Supplementary Information The online version contains supplementary material available at 10.1007/s00296-021-05069-x.

Autoimmune mucocutaneous blistering diseases after SARS-Cov-2 vaccination: A Case report of Pemphigus Vulgaris and a literature review

“…It may be speculated also that susceptible individuals with a pre-existing predisposition to autoimmune/autoinflammatory dysregulation may present a higher risk of immunological side effects after the administration of such vaccines, some of which contains nucleic acids [35] . Nonetheless, a cause-effect relationship cannot be established, although the presence of a temporal correlation may be suggestive of this event [37] .…”

New Onset of Eosinophilic Granulomatosis with Polyangiitis Following mRNA-Based COVID-19 Vaccine

“…All cases, including ours, occurred following an mRNA vaccine. A case-based review analyzing 29 cases of ANCA-associated vasculitis (AAV) arising in concomitance of anti-SARS-CoV-2 vaccines showed that 75% of patients developed the condition following mRNA vaccines, and that pANCA was most frequently identified [ 20 ]. Interestingly, a study on a patient who developed AAV following mRNA-based influenza vaccination showed enhanced in vitro ANCA production upon exposure to RNA-based influenza and rabies vaccines, but not for other influenza vaccines or when mRNA-based vaccines were previously treated with ribonuclease or toll-like receptor (TLR) 7 antagonists [ 21 ].…”

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

“…The evidence that there have been more reported cases of ANCA vasculitis following mRNA vaccines than following mRNA vector vaccines supports the idea. 4 Furthermore, the lipid-nanoparticle-formulated mRNA vaccines coding for the SARS-CoV-2 full-length spike protein can induce immunogenic pathways. 10 It has been previously demonstrated that mRNA vaccines can promote more robust adaptive and native immune reactions via prolonged S-specific germinal center B-cell responses and antigen-specific Th1-skewed immunity.…”

“… 3 Despite that the immune responses after natural infection with SARS-CoV-2 and mRNA vaccination could differ, there have been concerns about antineutrophil cytoplasmic antibody (ANCA) vasculitis after COVID-19 vaccines. 4 …”