key: cord-0735210-0ww7amu9
authors: Zavala-Miranda, María Fernanda; González-Ibarra, Samantha G.; Pérez-Arias, Abril A.; Uribe-Uribe, Norma O.; Mejia-Vilet, Juan M.
title: New onset systemic lupus erythematosus opening as class V lupus nephritis after COVID-19 vaccination
date: 2021-09-22
journal: Kidney Int
DOI: 10.1016/j.kint.2021.09.009
sha: 522fa4eccda91940e60054505c9d55a6b933cd8c
doc_id: 735210
cord_uid: 0ww7amu9

nan

To the editor:

We read in this journal the report of a 42-year-old woman with a previous diagnosis of systemic lupus erythematosus and class V lupus nephritis that developed a flare one week after vaccination with the mRNA COVID-19 vaccine BNT162b2 1 . Here, we report a case of a 23-year-old woman that presented with nephrotic syndrome one week after vaccination with the first dose of the AZD1222 (ChAdOx1-S) nCoV-19 vaccine.

She had no previous medical history of disease and no medications. She had not been previously infected by SARS-CoV-2. Her family history was negative for autoimmune diseases. On July 21 st , she was vaccinated without major adverse events. One week later she developed abrupt eyelid edema and foamy urine that progressed to anasarca within days. She also referred hair loss. Physical examination showed normal blood pressure and pitting edema up to the thighs.

Her laboratories showed lymphopenia (1000 x 10 3 /L), serum creatinine 0.8mg/dL (eGFR 104mL/min/1.73m 2 ), serum albumin 1.57g/dL, total cholesterol 351mg/dL, proteinuria 12.6g/24h (protein to creatinine ratio 11.0mg/mg), complement C3 85mg/dL (reference 87-200mg/dL), C4 12mg/dL (reference 19-52mg/dL). The T-cells are key to stimulate the immune response to vaccination. From phase 1 and 2 trials of the AZD1222 nCoV-19 vaccine, it has been shown that the spikespecific effector T-cell response presents early, from the 8 th -day post-vaccination and through day 56 7 . There is a robust Th1 response with an expansion of CD8+ T cells, with increases in cytokines such as tumor necrosis factor, interleukin-2, and interferon gamma. However, no Th2 response has been found after AZD1222 nCoV-19 8 .

Until now, there are no mechanisms of triggers to support a direct causal relationship between COVID-19 vaccination and SLE flares 9 . In this case, it is plausible that the immune response elicited by vaccination may have detonated systemic lupus erythematosus emergence in an immunological predisposed individual. It will be necessary to closely follow patients with SLE after vaccination, and register post-vaccination events in multinational registries 3 .

J o u r n a l P r e -p r o o f

Relapse of class V lupus nephritis after vaccination with COVID-19 mRNA vaccine

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

Tolerance of COVID-19 vaccination in patients with systemic lupus erythematosus: the international VACOLUP study

T-cells and autoimmune kidney disease

Membranous glomerulonephritis development with Th2-type immune deviations in MRL/lpr mice deficient for IL-27 receptor (WSX-1)

Predominance of Th1 immune response in diffuse proliferative lupus nephritis

Could mixing COVID vaccines boost immune response?

T-cell mediated immunity after AZD1222 vaccination: A polyfunctional spike-specific Th1 response with a diverse TCR repertoire