key: cord-0681982-36ddkewz
authors: Villa, Miguel; Díaz-Crespo, Francisco; Pérez de José, Ana; Verdalles, Úrsula; Verde, Eduardo; Ruiz, Fernando Almeida; Acosta, Adriana; Mijaylova, Antonia; Goicoechea, Marian
title: “A case of ANCA-associated vasculitis after AZD1222 (Oxford-AstraZeneca) SARS-CoV-2 vaccination: Casuality or causality?”
date: 2021-08-17
journal: Kidney Int
DOI: 10.1016/j.kint.2021.07.026
sha: 30eb0fd2aac3d689f3b015fd357e8b577c07ec97
doc_id: 681982
cord_uid: 36ddkewz

nan

To the editor:

Two cases of anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis after SARS-CoV-2 vaccination have been reported to date, and both appeared after Moderna (mRNA) vaccination 1,2 .

We report a case of a 63-year-old man with non-relevant medical background, previously normal kidney function, and no previous adverse reactions to vaccination. He was admitted to the hospital after noting 3 episodes of hemoptysis 7 days after his first dose of AZD1222 vaccine. He had taken acetaminophen and acetylsalicylic acid for a flu-like syndrome which appeared 48 hours after vaccination. Diagnostic workup showed creatinine 257.2 µmol/l with proteinuria ++ and mild hematuria. Chest x-ray showed infiltration in the left lower lung field. Diagnostic tests for SARS-CoV-2 were negative. AntiMPO antibodies (pANCA) were positive (12 UI/ml). Treatment for ANCA-associated vasculitis was initiated (high-dose intravenous glucocorticoids, followed by a tapering course of oral prednisone reduction (60 mg/d for 1 month followed by a decrease of 10 mg every 2 weeks), and oral cyclophosphamide). Plasma exchange was not instutited as the hemoptysis was self-limited without anemia or hemodynamic instability. Kidney biopsy showed focal extracapillary proliferation and crescent formation, resulting in a diagnosis of a focal class of ANCA-associated pauci-immune glomerulonephritis according to the Berden Classification (Figure 1) . Hemoptysis disappeared during admission, and progressive recovery of kidney function was observed. Creatinine improved initially with high-dose glucocorticoids to 247,5 µmol/l 5 days after admission, creatinine was 252 µmol/l at discharge after 18 days of admission, and the last creatinine was 184.8 µmol/l after 6 weeks of treatment. Our patient had not developed an antibody response to the SARS-CoV-2 spike protein 2 months after the first AZD1222 vaccine.

No cases of ANCA vasculitis have been reported after viral vector COVID-19 vaccines, but they have been described after Influenza vaccination 3 . This is the first case of ANCA vasculitis after AZD1222 vaccine so far 4 . In our patient causality is based on temporal association although we cannot demonstrate a direct link with vaccination.

All the authors declared no competing interests. 

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Vasculitis Following Influenza Vaccination: A Review of the Literature

De Novo and Relapsing Glomerular Diseases After COVID-19 Vaccination: What Do We Know So Far?