ABSTRACT
Introduction/Objective COVID-19 vaccine-related lymphadenopathy, particularly in the ipsilateral axilla, is a relatively well-known side effect of mRNA vaccines with many reports in radiology, but less is known regarding histopathology and additional sites of lymphadenopathy, as well as other localized potential vaccine-related mass manifestations. In addition to a case of minimal change disease, we report two cases here with associated systemic and local pathologic changes related to COVID-19 vaccination. Methods/Case Report In case #1, a 17-year-old male presented with a 2.4 cm left postauricular mass. He had originally noticed the mass six months prior and thought that it had recently been growing. The mass was soft, nonfluctuant, and nontender to palpation. Given the risk of malignancy, a resection was performed. Histology showed an enlarged lymph node composed of mixed inflammatory cell components consistent with lymphoid hyperplasia and no evidence of malignancy. On further chart review, the patient had received his second COVID-19 vaccination just prior to noticing the mass enlarging. A SARS-CoV-2 Anti-Spike IgG assay was as high as 24,396 AU/ml, suggesting that this benign lymphadenopathy was most likely related to his vaccination. For case #2, a 47-year-old male developed a painless right deltoid mass shortly after receiving his vaccination at the same area that subsequently increased in size over seven months to 6.5 cm. Imaging showed a heterogeneous mass within the deltoid muscle concerning for malignancy and a biopsy was performed. Sections showed wavy, bland spindle cells with nuclei staining diffusely positive for beta-catenin, consistent with fibromatosis at his vaccination site. Results (if a Case Study enter NA) NA. Conclusion In summary, these case reports show potential systemic and local reactive effects in response to COVID-19 vaccination.
ABSTRACT
Background: Kidney injury molecule-1 (KIM-1), a type-1 transmembrane glycoprotein, has been well studied as a specific injury marker for proximal tubules (PT). KIM-1 functions as a receptor for apoptotic fragments through a phagocytic process. KIM-1 (also called TIM-1) serves as a receptor for hepatitis A virus and Ebola virus, and possibly for severe respiratory syndrome-coronavirus (SARS-CoV-1). During the pandemic spread of coronavirus disease 2019 (COVID-19), many patients have suffered from acute kidney injury (AKI) as well as lung damage, Viral upkake has been attributed to interactions with ACE2, a receptor for the virus. The goal of this study was to investigate whether there is kidney histological data that KIM-1 may also serve as a receptor for SARS-CoV-2 to infect the PT. Methods: Two patients (one adult and one child) who died of COVID19 and 10 patients with AKI but no COVID19 (control group) were included in the study. All kidney tissue sections were stained for KIM-1 (monoclonal AKG7 antibody) and scored from 0 to 3+. Electron microscopy was conducted using kidney tissue of the COVID19+ patients. Results: Both COVID19+ patients had normal pre-mortem levels of serum creatinine (sCr) (adult 0.63 and child 0.17 mg/dl), whereas the control cases all had elevated sCr (1.9 to 10.7 mg/dl). Control renal biopsies revealed positive KIM-1 staining ranging from 1+ to 3+ along the surface of PT in a patchy pattern involving 20 to 80% of the cortex;no cytoplasmic granular materials were identified. By contrast, the KIM-1 staining in COVID19+ kidneys revealed spotty granular staining in the cytoplasm and diffuse surface 2+ to 3+ staining in most PTs, while glomeruli stained negatively for KIM-1 as internal negative controls. In the two COVID19+ patients, SARS-CoV-2 particles showed spiking-crown appearances with sizes ranging from 70 to 110 nm in the PT cytoplasm by ultrastructural studies. Conclusions: Our initial evidence suggests there is an atypical staining pattern of KIM-1 in the PT of COVID19+ patients, raising a possibility that KIM-1 may serve as a receptor for SARS-CoV-2. KIM-1 may also serve to internalize the virus into the PT. In addition the two COVID+ patients had normal sCr levels but positive KIM-1 staining, indicating that sCr underestimates renal injury caused by SAR-CoV-2 infection.