J Korean Med Sci.  2023 Oct;38(41):e341. 10.3346/jkms.2023.38.e341.

De Novo ANCA-Negative Pauci-Immune Crescentic Glomerulonephritis After COVID-19 mRNA Vaccination: A Case Report

• Cho H
• Lee HS
• Kim SH
• Shin J
• Hwang JH

• KMID: 2547179
• DOI: http://doi.org/10.3346/jkms.2023.38.e341

Abstract

To prevent the spread of the coronavirus disease 2019 (COVID-19) pandemic, vaccines have been authorized for emergency use and implemented worldwide. We present a case of de novo glomerulonephritis (GN) after use of the COVID-19 mRNA vaccine BNT162b2. A 48-year-old man with no relevant medical history was referred for sudden and persistent worsening of renal insufficiency 1.5 months after the second vaccine dose. He had arthralgia and skin rash a week after vaccination. Abdominal pain and diarrhea started 2 weeks later, and he was admitted to the hospital for enteritis treatment. Colonoscopy showed multiple ulcerations and petechiae suggestive of vasculitis in the terminal ileum. After prednisolone therapy, his gastrointestinal symptoms improved, but his renal function continued to deteriorate. Based on kidney biopsy findings and nephrotic-range proteinuria (5,306 mg/24 hours), he was diagnosed with anti-neutrophil cytoplasmic autoantibody (ANCA)-negative pauci-immune crescentic GN (CrGN). He received high-dose steroid pulse therapy and oral cyclophosphamide, and then, gradually underwent steroid tapering, with improvement in proteinuria and renal function over several weeks. Several cases of GN suspected to be related to COVID-19 vaccines have been reported. To our knowledge, this is the first case report of ANCA-negative pauci-immune crescentic CrGN with extrarenal involvement after COVID-19 mRNA vaccination. Our finding expands the spectrum of COVID-19 vaccine-associated GN.

Keyword

Anti-Neutrophil Cytoplasmic Antibody; Coronavirus Disease 2019; COVID-19 mRNA Vaccines; Glomerulonephritis; Pauci-Immune Vasculitis

Figure

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  Fig. 1 Major events, the Cr level, and the eGFR during the clinical course.Cr = creatinine, eGFR = estimated glomerular filtration rate.

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  Fig. 2 Renal pathologic findings confirmed through renal biopsy. (A) Low-power field image of a biopsy specimen. (B) Fibrocellular crescent (black arrow) seen in 79% of glomeruli. (C) Increased size of the glomerulus and mild hypercellular mesangium (arrow head). (D) Fibrocellular crescent (black arrow), focal marked tubular atrophy and loss with infiltration of mononuclear cells, and fibrosis in the interstitium (red asterisk).

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