key: cord-0747778-0vmvx1fh
authors: Kim, Hyo Jeong; Jung, Minsun; Lim, Beom Jin; Han, Seung Hyeok
title: New Onset of Class III Lupus Nephritis with Multi-Organ Involvement after COVID -19 Vaccination
date: 2022-01-31
journal: Kidney Int
DOI: 10.1016/j.kint.2022.01.013
sha: 6bcfcc02814be0aebcb2b1efd165917a51636ed6
doc_id: 747778
cord_uid: 0vmvx1fh

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To the editor: Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can trigger an autoimmune response. There have been two cases of lupus nephritis after administration of the mRNA vaccine (BNT162b2, Pfizer-BioNTech) and the adenoviral vector vaccine (AZD1222 [ChAdOx1-S], Astra-Zeneca). 1, 2 We present a case of lupus nephritis combined with multi-organ involvement after administration of the AZD1222 vaccine.

In 2015, a 60-year-old female was treated with oral corticosteroids for skin rash at a private dermatologic clinic. It was an itchy, brownish skin lesion with erythematous macular patches on both medial malleolar area. At that time, she was told she might have autoimmune disease based Immunofluorescence revealed typical 'full-house' pattern ( Figure 1A-2) . Electron microscopy confirmed electron-dense deposits ( Figure 1A-3) . Chest computed tomography (CT) showed patchy, nodular consolidations ( Figure 1B-1) . A cotton wool spot lesion on funduscopic examination ( Figure 1C ).

We started treatment with intravenous pulse methylprednisolone and intravenous cyclophosphamide followed by oral prednisolone and hydroxychloroquine. 10 days after treatment, serum creatinine and UPCR level decreased to 0.93mg/dL, 1.64g/g, respectively. A repeat chest CT scan showed a marked resolution of consolidations ( Figure 1B-2) .

There have been increasing occurrences of glomerulonephritis including minimal change disease, membranous nephropathy and IgA nephropathy after COVID-19 vaccination. The AZD 1222 vaccine can induce Th1 responses with an expansion of CD8+ T cells and enhance cytokine production. It is hypothesized that there is cross-reactivity between antibodies against the SARS-CoV-2 S protein and different tissue antigens, leading to autoimmune diseases. 3, 4 Thus, we believe that COVID-19 vaccine was a key trigger that elicited an autoimmune response and the development of lupus nephritis in our patient. 

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