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Abstract: FR-PO047

ANCA-Associated Vasculitis Following Johnson & Johnson COVID-19 Vaccine in Nepal

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Ranabhat, Kamal, Government of Nepal Ministry of Health and Population, Kathmandu, Bagmati, Nepal
  • Shah, Sangam, Tribhuvan University Institute of Medicine, Maharajgunj, Bagmati, Nepal
Introduction

Antineutrophil cytoplasmic autoantibodies (ANCA) associated vasculitis (AAV) after influenza vaccination has been previously reported, there are a very few case reports of AAV following COVID-19 vaccination.

Case Description

A 52-year-old hypertensive female presented with complaints of fever, joint pain, and weakness of all limbs. She developed symptoms 12 days after getting vaccinated with Johnson and Johnson (J & J) COVID-19 vaccine in late July 2021. The fever occurred for 10 days, intermittent type, and associated with chills and rigor. The joint pain was for 3 days which was acute in onset involving small joints of hands and feet. Concurrently she also developed weakness of all four limbs with relatively more weakness in lower limb than upper limbs. She consumed alcohol occasionally. Urinalysis revealed 12 red blood cells per high-power field (HPF), 4 white blood cells/HPF, and 0.631 gm/day protein with albumin (2+). Serologic evaluation was notable for increased C-reactive protein, decreased C3 complement level, normal C4 level, positivity for p-ANCA and c-ANCA (3+). Renal ultrasound showed tiny non-obstructive calculus in both kidneys. Following this she was started on antibiotics, NSAIDS, and methylprednisolone. She was planned for kidney biopsy and was started on cyclophosphamide. Blood transfusion was done. Renal biopsy revealed necrotizing and crescentic glomerulonephritis with insignificant glomerular immune complex deposit suggesting ANCA associated glomerulonephritis in the view of history of ANCA positivity (Figure 1). She was discharged after 10 days of hospitalization.

Discussion


AAV following adenovirus vector vaccine has not been reported previously. There have been reports of AAV after administration of influenza vaccine. So, J&J vaccines was thought to be a potential trigger for development of AAV. The temporal causal association between autoimmune manifestations like AAV and COVID-19 vaccines can be explained by hypothesized mechanisms like molecular mimicry, defective neutrophilic apoptosis, polyclonal activation, and systemic proinflammatory cytokine response.

Figure 1(left & right): Immune complex deposit