Development of Alveolar Hemorrhage After Pfizer-BioNTech COVID-19 mRNA Vaccination in a Patient With Renal-Limited Anti-neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Case Report

Ken Nishioka, Shintaro Yamaguchi, Itaru Yasuda, Norifumi Yoshimoto, Daiki Kojima, Kenji Kaneko, Mitsuhiro Aso, Tomoki Nagasaka, Eriko Yoshida, Kiyotaka Uchiyama, Takaya Tajima, Jun Yoshino, Tadashi Yoshida, Takeshi Kanda, Hiroshi Itoh

Research output: Contribution to journalArticlepeer-review

Abstract

Since the coronavirus disease 2019 (COVID-19) pandemic continues and a new variant of the virus has emerged, the COVID-19 vaccination campaign has progressed. Rare but severe adverse outcomes of COVID-19 vaccination such as anaphylaxis and myocarditis have begun to be noticed. Of note, several cases of new-onset antineutrophil cytoplasmic antibody-associated vasculitis (AAV) after COVID-19 mRNA vaccination have been reported. However, relapse of AAV in remission has not been recognized enough as an adverse outcome of COVID-19 vaccination. We report, to our knowledge, a first case of renal-limited AAV in remission using every 6-month rituximab administration that relapsed with pulmonary hemorrhage, but not glomerulonephritis, following the first dose of the Pfizer-BioNTech COVID-19 vaccine. The patient received the COVID-19 vaccine more than 6 months after the last dose of rituximab according to the recommendations. However, his CD19+ B cell counts were found to be increased after admission, indicating that our case might have been prone to relapse after COVID-19 vaccination. Although our case cannot establish causality between AAV relapse and COVID-19 mRNA vaccination, a high level of clinical vigilance for relapse of AAV especially in patients undergoing rituximab maintenance therapy following COVID-19 vaccination should be maintained. Furthermore, elapsed time between rituximab administration and COVID-19 mRNA vaccination should be carefully adjusted based on AAV disease-activity.

Original languageEnglish
Article number874831
JournalFrontiers in Medicine
Volume9
DOIs
Publication statusPublished - 2022 Apr 8

Keywords

  • COVID-19 mRNA vaccination
  • alveolar hemorrhage
  • relapse
  • renal-limited ANCA-associated vasculitis
  • rituximab

ASJC Scopus subject areas

  • Medicine(all)

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