ANCA-Associated Vasculitis Following the Pfizer-BioNTech COVID-19 Vaccine

Shakoor, Muhammad Tariq; Birkenbach, Mark P.; Lynch, Matthew

SARS-CoV-2 continues to spread around the world. As of June 28(th) 2021, there are approximately 181 million confirmed cases and more than 3.9 million deaths across the globe. The colossal impact of COVID19 is driving the biggest vaccination campaign in human history. All three vaccines (Pfizer-BioNTech, Moderna and J&J) authorized for emergency use by FDA have been thoroughly studied and found to be safe and effective in preventing severe COVID-19 cases. While short-term side effects of COVID-19 vaccine resemble those of other vaccines, long-term side effects remain unknown. Rare side effects continue to surface as millions of people receive COVID19 vaccines around the world as compared with the thousands enrolled in the clinical trials. We report a case of new onset renal limited ANCA-associated (AAV) vasculitis in a 78 year old woman with previously normal kidney function after receiving the Pfizer-BioNTech COVID-19 vaccine. The patient developed AKI with proteinuria and microscopic hematuria with many dysmorphic red blood cells in the urine. Anti-myeloperoxidase (MPO) antibody titer was elevated. Kidney biopsy showed pauci-immune crescentic necrotizing glomerulonephritis. Kidney function improved after treatment with steroids and rituximab. Our patient had normal routine lab work before the vaccination. Although this case cannot demonstrate a causal relationship between COVID19 vaccination and AAV, ongoing surveillance for similar complications would be prudent as worldwide vaccination efforts continue.