Abstract: SA-PO0802
New Onset of Class IV Lupus Nephritis After Monkeypox Vaccination
Session Information
- Glomerular Diseases: Lupus Nephritis, Monoclonal Gammopathy-Related Disease, and Transplantation
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Gentle, Eric, Dignity Health St.Rose San Martin, Las Vegas, Nevada, United States
- Awuah-Saadiq, Paulina, Dignity Health St.Rose San Martin, Las Vegas, Nevada, United States
- Sorato, Beatriz, Dignity Health St.Rose San Martin, Las Vegas, Nevada, United States
Introduction
Lupus nephritis is a severe manifestation of systemic lupus erythematosus caused by immune complex deposition and complement activation within the glomeruli. Although vaccines are generally safe in autoimmune disease, rare cases of immune-mediated renal disease following vaccination have been reported.
Case Description
A 27-year-old male with Sjögren’s syndrome and remote immune thrombocytopenic purpura developed progressive lower extremity edema one week after monkeypox vaccination. Laboratory studies showed acute kidney injury (serum creatinine 2.15 mg/dL), nephrotic-range proteinuria, severe hypoalbuminemia (1.6 g/dL), active urinary sediment, and hypocomplementemia. Serologic testing was negative for ANCA.Kidney biopsy demonstrated diffuse proliferative and membranous lupus nephritis (ISN/RPS Class IV/V). Light microscopy showed diffuse endocapillary hypercellularity involving greater than 50% of glomeruli with wire-loop lesions and hyaline thrombi. Immunofluorescence revealed a granular “full house” staining pattern. Electron microscopy demonstrated abundant subendothelial and subepithelial immune complex deposits with tubuloreticular inclusions. Activity index was 6/24 with minimal chronicity (1/12), consistent with active and potentially reversible disease.The patient was treated with prednisone and mycophenolate mofetil with improved renal function and proteinuria.
Discussion
This case describes new-onset, biopsy-proven lupus nephritis occurring shortly after monkeypox vaccination in a patient with underlying autoimmune disease. Although causality cannot be established, the timing raises concern for immune activation in a susceptible individual. Most reported cases of vaccine-associated lupus nephritis involve mRNA COVID-19 vaccines, with very few cases reported after monkeypox vaccination. This case also highlights the importance of early nephrology evaluation and kidney biopsy in patients presenting with nephrotic-range proteinuria and new renal dysfunction after immune stimulation.