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Development of Alveolar Hemorrhage After Pfizer-BioNTech COVID-19 mRNA Vaccination in a Patient With Renal-Limited Anti-neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Case Report
Since the coronavirus disease 2019 (COVID-19) pandemic continues and a new variant of the virus has emerged, the COVID-19 vaccination campaign has progressed. Rare but severe adverse outcomes of COVID-19 vaccination such as anaphylaxis and myocarditis have begun to be noticed. Of note, several cases...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9023855/ https://www.ncbi.nlm.nih.gov/pubmed/35462990 http://dx.doi.org/10.3389/fmed.2022.874831 |
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author | Nishioka, Ken Yamaguchi, Shintaro Yasuda, Itaru Yoshimoto, Norifumi Kojima, Daiki Kaneko, Kenji Aso, Mitsuhiro Nagasaka, Tomoki Yoshida, Eriko Uchiyama, Kiyotaka Tajima, Takaya Yoshino, Jun Yoshida, Tadashi Kanda, Takeshi Itoh, Hiroshi |
author_facet | Nishioka, Ken Yamaguchi, Shintaro Yasuda, Itaru Yoshimoto, Norifumi Kojima, Daiki Kaneko, Kenji Aso, Mitsuhiro Nagasaka, Tomoki Yoshida, Eriko Uchiyama, Kiyotaka Tajima, Takaya Yoshino, Jun Yoshida, Tadashi Kanda, Takeshi Itoh, Hiroshi |
author_sort | Nishioka, Ken |
collection | PubMed |
description | Since the coronavirus disease 2019 (COVID-19) pandemic continues and a new variant of the virus has emerged, the COVID-19 vaccination campaign has progressed. Rare but severe adverse outcomes of COVID-19 vaccination such as anaphylaxis and myocarditis have begun to be noticed. Of note, several cases of new-onset antineutrophil cytoplasmic antibody-associated vasculitis (AAV) after COVID-19 mRNA vaccination have been reported. However, relapse of AAV in remission has not been recognized enough as an adverse outcome of COVID-19 vaccination. We report, to our knowledge, a first case of renal-limited AAV in remission using every 6-month rituximab administration that relapsed with pulmonary hemorrhage, but not glomerulonephritis, following the first dose of the Pfizer-BioNTech COVID-19 vaccine. The patient received the COVID-19 vaccine more than 6 months after the last dose of rituximab according to the recommendations. However, his CD19(+) B cell counts were found to be increased after admission, indicating that our case might have been prone to relapse after COVID-19 vaccination. Although our case cannot establish causality between AAV relapse and COVID-19 mRNA vaccination, a high level of clinical vigilance for relapse of AAV especially in patients undergoing rituximab maintenance therapy following COVID-19 vaccination should be maintained. Furthermore, elapsed time between rituximab administration and COVID-19 mRNA vaccination should be carefully adjusted based on AAV disease-activity. |
format | Online Article Text |
id | pubmed-9023855 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-90238552022-04-23 Development of Alveolar Hemorrhage After Pfizer-BioNTech COVID-19 mRNA Vaccination in a Patient With Renal-Limited Anti-neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Case Report Nishioka, Ken Yamaguchi, Shintaro Yasuda, Itaru Yoshimoto, Norifumi Kojima, Daiki Kaneko, Kenji Aso, Mitsuhiro Nagasaka, Tomoki Yoshida, Eriko Uchiyama, Kiyotaka Tajima, Takaya Yoshino, Jun Yoshida, Tadashi Kanda, Takeshi Itoh, Hiroshi Front Med (Lausanne) Medicine Since the coronavirus disease 2019 (COVID-19) pandemic continues and a new variant of the virus has emerged, the COVID-19 vaccination campaign has progressed. Rare but severe adverse outcomes of COVID-19 vaccination such as anaphylaxis and myocarditis have begun to be noticed. Of note, several cases of new-onset antineutrophil cytoplasmic antibody-associated vasculitis (AAV) after COVID-19 mRNA vaccination have been reported. However, relapse of AAV in remission has not been recognized enough as an adverse outcome of COVID-19 vaccination. We report, to our knowledge, a first case of renal-limited AAV in remission using every 6-month rituximab administration that relapsed with pulmonary hemorrhage, but not glomerulonephritis, following the first dose of the Pfizer-BioNTech COVID-19 vaccine. The patient received the COVID-19 vaccine more than 6 months after the last dose of rituximab according to the recommendations. However, his CD19(+) B cell counts were found to be increased after admission, indicating that our case might have been prone to relapse after COVID-19 vaccination. Although our case cannot establish causality between AAV relapse and COVID-19 mRNA vaccination, a high level of clinical vigilance for relapse of AAV especially in patients undergoing rituximab maintenance therapy following COVID-19 vaccination should be maintained. Furthermore, elapsed time between rituximab administration and COVID-19 mRNA vaccination should be carefully adjusted based on AAV disease-activity. Frontiers Media S.A. 2022-04-08 /pmc/articles/PMC9023855/ /pubmed/35462990 http://dx.doi.org/10.3389/fmed.2022.874831 Text en Copyright © 2022 Nishioka, Yamaguchi, Yasuda, Yoshimoto, Kojima, Kaneko, Aso, Nagasaka, Yoshida, Uchiyama, Tajima, Yoshino, Yoshida, Kanda and Itoh. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Medicine Nishioka, Ken Yamaguchi, Shintaro Yasuda, Itaru Yoshimoto, Norifumi Kojima, Daiki Kaneko, Kenji Aso, Mitsuhiro Nagasaka, Tomoki Yoshida, Eriko Uchiyama, Kiyotaka Tajima, Takaya Yoshino, Jun Yoshida, Tadashi Kanda, Takeshi Itoh, Hiroshi Development of Alveolar Hemorrhage After Pfizer-BioNTech COVID-19 mRNA Vaccination in a Patient With Renal-Limited Anti-neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Case Report |
title | Development of Alveolar Hemorrhage After Pfizer-BioNTech COVID-19 mRNA Vaccination in a Patient With Renal-Limited Anti-neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Case Report |
title_full | Development of Alveolar Hemorrhage After Pfizer-BioNTech COVID-19 mRNA Vaccination in a Patient With Renal-Limited Anti-neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Case Report |
title_fullStr | Development of Alveolar Hemorrhage After Pfizer-BioNTech COVID-19 mRNA Vaccination in a Patient With Renal-Limited Anti-neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Case Report |
title_full_unstemmed | Development of Alveolar Hemorrhage After Pfizer-BioNTech COVID-19 mRNA Vaccination in a Patient With Renal-Limited Anti-neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Case Report |
title_short | Development of Alveolar Hemorrhage After Pfizer-BioNTech COVID-19 mRNA Vaccination in a Patient With Renal-Limited Anti-neutrophil Cytoplasmic Antibody-Associated Vasculitis: A Case Report |
title_sort | development of alveolar hemorrhage after pfizer-biontech covid-19 mrna vaccination in a patient with renal-limited anti-neutrophil cytoplasmic antibody-associated vasculitis: a case report |
topic | Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9023855/ https://www.ncbi.nlm.nih.gov/pubmed/35462990 http://dx.doi.org/10.3389/fmed.2022.874831 |
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