Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Renal Vasculitis Following COVID-19 Vaccination: A Case Report and Literature Review

Abstract

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is an immune-mediated disorder of small and medium-sized vessels, characterized by the production of autoantibodies that target the neutrophilic antigens leading to mononuclear cell infiltration and destruction of blood vessels in lungs, skin, and kidneys. Although rare, the coronavirus disease 2019 (COVID-19) vaccine may trigger autoimmune vasculitis. We report a rare case of ANCA-associated renal vasculitis following COVID-19 vaccination in a 59-year-old male who presented with flu-like symptoms and deranged renal function tests. He received his second dose of the Pfizer COVID-19 vaccine 17 days ago. His clinical picture, serological testing, and radiological imaging were concerned with glomerular disease. His serum was positive for ANCAs, and the renal biopsy specimen revealed pauci-immune glomerulonephritis. He was diagnosed with AAV-associated renal vasculitis following COVID-19 vaccination because no other etiology was identified. His clinical improvement after starting rituximab and steroids reinforced the diagnosis.

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

“…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%).…”

Seguridad de la vacunación COVID-19 en una muestra de pacientes brasileños con lupus eritematoso sistémico

“…Regarding COVID-19 vaccination, the toll-like receptor used as an adjuvant has the potential to induce SLE flares, upregulating the type I interferon pathway 25 . Several autoimmune phenomena have been described following vaccination, such as ANCAassociated vasculitis 26 , myositis 27 , autoimmune hemolytic anemia 28 , and thrombocytopenic purpura 29 , among others. However, the existing data is mostly based on case descriptions.…”

ANCA Glomerulonephritis after COVID-19 and post-COVID-19 vaccination – current state of knowledge

“…The vaccine may activate a cascade of pathways through dendritic and bone marrow cell stimulation, leading to autoinflammation [36,50,51]. Moreover, a series of cases showed that some patients developed dual-positive anti-GBM and MPO ANCA glomerulonephritis after mRNA COVID-19 vaccination, with outcomes varying from complete remission to dialysis dependence or death [5,52].…”

“…Thammathiwat and colleagues in their study emphasized the need to avoid unnecessary booster doses of COVID-19 vaccines in highrisk patients (carriers of HLA-DR4 or DRB4 alleles) [48,55]. Renal vasculitis induced by the COVID-19 vaccine is rare, and mass vaccination against COVID-19 infection globally is the appropriate strategy to combat this serious viral disease [5]. Table 4 summarizes the published cases of ANCAassociated renal vasculitis after COVID-19 vaccination [55].…”

“…Various factors can trigger autoimmune reactions, including infectious agents and even vaccines, which may contribute to the development of AAV and autoimmunization [4]. Several cases of ANCA-associated vasculitis of the kidneys following COVID-19 illness and induced by the COVID-19 vaccine have been described in the literature [5].…”