Various diseases associated with COVID-19 vaccines have
been reported. A recent case study indicated that COVID-19 vaccination may
trigger the development of anti-neutrophil cytoplasmic antibodies
(ANCA)-associated vasculitis, potentially damaging multiple organs. Among 29
patients, five underwent plasmapheresis treatment (the separation and
replacement of plasma from blood), and five relied on dialysis therapy.
ANCA-associated vasculitis can cause damage to small
blood vessels. Since these are distributed throughout the body, any part of the
body can be affected, with the most common areas being the lungs, kidneys,
joints, ears, nose, and nerves.
Neutrophils are a type of white blood cell that aids the
body in fighting infection and healing injuries. ANCA are harmful
autoantibodies that bind to neutrophils in the blood, releasing toxic
substances and damaging the walls of small blood vessels. This can also result
in the migration of neutrophils through blood vessel walls, inducing
inflammation in the surrounding tissues. Additionally, it releases signaling
factors that attract even more neutrophils, perpetuating inflammation and
further damaging small blood vessels.
Case report of ANCA-associated vasculities
A case report published in Case
Reports in Nephrology in April 2023 detailed an 82-year-old woman with high
blood pressure who, after receiving her third booster COVID-19 vaccine booster,
developed myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA)-associated
vasculitis. MPO-ANCA is one of the primary autoantibodies in ANCA-associated
vasculitis.
The patient received two doses of the
Pfizer vaccine in May and June 2021, followed by a Moderna booster shot in
early February 2022. The next day after the booster shot, she experienced a
headache, which subsided after three days. However, starting in early March,
her body temperature began to rise, accompanied by general malaise.
Upon examination, no apparent bacterial infection was
found, but blood tests revealed an inflammatory reaction. The C-reactive
protein level was elevated, and her white blood cell count was
13,000/microliters (the normal range is between 4,000 and 10,000/microliters),
suggesting a bacterial infection. The doctor prescribed antibiotics for seven
consecutive days, but there was no improvement.
The patient was later admitted to the hospital. Physical
examination and imaging tests did not reveal fever, and kidney size and
structure appeared normal. However, microscopic analysis uncovered hematuria
(blood in the urine) and urinary protein. Additionally, the MPO-ANCA level was
notably high. A kidney biopsy revealed cellular crescents in six glomeruli—the
tiny filters inside the kidneys—and mild inflammation.
Furthermore, immunofluorescence confirmed pauci-immune glomerulonephritis. This is a rare small
vessel vasculitis associated with rapidly progressive glomeruli inflammation,
clinically characterized by kidney issues such as urinary abnormalities
(hematuria and proteinuria) and high blood pressure resulting in kidney failure
within days or weeks. Based on the pathological findings, the patient was
diagnosed with renal-limited MPO-ANCA-associated vasculitis.
The patient was put on a steroid medication, and symptoms
such as fever, malaise, and inflammatory reaction improved, while both
hematuria and urinary protein disappeared. The doctor gradually reduced the
steroid dosage, cutting it in half, and the patient’s condition stabilized.
The researchers stated that blood and urine tests conducted
on the patient before her third vaccine dose did not reveal kidney damage or
abnormalities, suggesting an association between the COVID-19 vaccine and the
onset of MPO-ANCA-associated vasculitis.
The researchers suggested that the possibility of
MPO-ANCA-associated vasculitis should be considered for patients experiencing
fever, prolonged general malaise, hematuria, or kidney impairment after
receiving a COVID-19 mRNA vaccine, especially Moderna, as was the case with
this patient.
5 COVID-19 vaccines related to ANCA-associated vasculitis
An increasing number of reports indicate that widespread
vaccination has led to the development of vasculitis in some people, resulting
in damage to multiple organs.
A case-based review reported five types of COVID-19
vaccines linked to ANCA-associated vasculitis.
The study included cases from 29 patients, with 22
receiving mRNA vaccines (Moderna and Pfizer), four receiving AstraZeneca, two
receiving Covaxin, and one receiving Johnson & Johnson. They all exhibited
symptoms of ANCA-associated vasculitis after receiving one of these COVID-19
vaccines.
Specifically, 22 patients exhibited kidney damage,
manifested as new-onset or recurrent glomerulonephritis. At least 24
individuals presented with hematuria. Ten experienced lung damage, with five
cases involving alveolar hemorrhage. One person developed optic neuritis, and
another had auricular chondritis. These are manifestations of organ damage
following vaccine administration.
Most patients received immunosuppressive treatment,
including steroid medications. Additionally, five underwent plasma exchange,
and at least five patients continued to rely on dialysis at the last follow-up.
The study mentioned that mRNA vaccines may stimulate
myeloid and dendritic cells to varying degrees, activating downstream pathways
to generate autoinflammation. Furthermore, mRNA vaccines generate
antiviral-neutralizing antibodies and activate CD8+ and CD4+ T cells,
triggering strong immune responses. Compared to natural infection, mRNA
vaccines may enhance innate and acquired immunity stimulation. In some
individuals with compromised immune systems, the ability to clear nucleic acids
may decrease, potentially impacting neutrophils.
Vasculitis may lead to multiorgan failure
There are different types of ANCA-associated vasculitis,
including microscopic polyangiitis, where the frequency of MPO-ANCA positivity
is notably high.
According to data from the Japan Intractable Diseases Information Center,
approximately 70 percent of patients with microscopic polyangiitis experience
systemic symptoms, including fever, weight loss, and fatigue. Additionally,
symptoms such as hemorrhage, ischemia, or infarction in body tissues may occur.
Necrotizing glomerulonephritis is the most common,
presenting with symptoms like hematuria, protein in urine, and elevated serum
creatinine. Early diagnosis is crucial, as the condition often progresses
rapidly to kidney failure within weeks to months. Other prevalent
manifestations include rash, with livedo reticularis, purpura, skin ulcers, and
subcutaneous nodules in approximately 60 percent of patients with necrotizing
glomerulonephritis. Polyneuropathy is observed in about 60 percent, joint pain
in around 50 percent, and muscle pain in roughly 50 percent of cases.
Additionally, interstitial pneumonia is seen in
approximately 25 percent, and alveolar hemorrhage in about 10 percent. Both
conditions are attributed to vasculitis affecting the pulmonary capillaries,
leading to cough, shortness of breath, rapid breathing, coughing up blood,
bloody sputum, and severely low blood oxygen levels. Gastrointestinal
involvement occurs in around 20 percent of cases, and myocardial involvement
resulting in heart failure occurs in approximately 18 percent.
ANCA-associated vasculitis can be life-threatening if not
promptly treated. Early diagnosis and appropriate treatment lead to improvement
in the majority of cases. However, delayed treatment or poor response to
initial therapy may result in irreversible organ dysfunction, necessitating
procedures such as blood dialysis for patients experiencing kidney failure.
Moreover, due to the possibility of symptom recurrence, patients should undergo
regular checkups with specialists.
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