ABSTRACT
Background: SARS CoV-2 vaccines, which demonstrated a high efficacy and a beneficial safety profile, could also represent a trigger factor for immune-mediated disease. We report a case of severe anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis following the mRNA vaccine for COVID-19, diagnosed de novo in February 2022 in a Nephrology Unit of Southern Italy. Case Report: A 21-year-old man of Moroccan origin, with a history of bronchial asthma, entered the hospital for respiratory distress and low-grade fever, occurred few days after the first administration of the BNT162b2 vaccine. He was discharged with oral steroid and antibiotic therapy. One day after the second dose, he entered the hospital again due to worsening of respiratory symptoms, fever, edema and papulo-erythematous/purpuric lesions on limbs and trunk. He underwent routine blood tests with these findings: hypereosinophilia (6.63x103cell/muL), increased creatinine (2.1 mg/dl), proteinuria (6 g/24h) and microhematuria (>1.0 mg/dL). Further laboratory tests showed increased levels of total IgE (6474 IU/ mL, normal value <100 IU/mL) and Eosinophilic Cationic Protein (109 mug/L, normal value <13 mug/L). Autoantibodies anti Myeloperoxidase (Anti-MPO) were positive with high levels (740 CU/mL, cut-off value <20 CU/mL). Additional instrumental examinations and renal biopsy confirmed the diagnosis of ANCA-associated vasculitis. The patient was treated with metilprednisolone (3 boluses of 1g/ day), then prednisone (1mg/kg/day) and 2 boluses of Rituximab (375mg/m2). After two months, the follow-up exams revealed normal serum creatinine level (0.8 mg/dl), reduction of proteinuria (3 g/24h), negative anti-MPO and complete remission of the respiratory status. Conclusion(s): Among the complications of anti COVID-19 vaccines, several cases of de novo or relapsed ANCAassociated vasculitis were recently reported. We described a new case, onset in a younger man than previous studies. Even though the relationship between COVID-19 vaccination and development of autoimmune disease has only been suggested, an appropriate laboratory approach, in support of clinical surveillance for immunological complications, should be helpful to diagnosis, monitoring and clarification of possible physiopathologic connection.
ABSTRACT
Background: Haemodialysis patients (HD) and kidney transplant recipients (RTx) are vulnerable populations at higher risk for coronavirus disease 2019 (COVID-19) because of their impaired immune status. They were considered a priority for COVID-19 vaccination, despite they were excluded from vaccine trials. We used laboratory testing for a prospective observational study in HD e RTx to evaluate humoral and cellular immunity after the third dose with BNT162b2 m-RNA vaccine and to compare, in both groups, the humoral response after the second and the third vaccine doses. Method(s): Patients were recruited from two Nephrology Unit of Southern Italy. The study was performed in 99 patients divided in two homogeneous groups: RTX (n=49) and HD (n=50). Samples were collected twelve weeks after the vaccination doses with BNT162b2. A chemiluminescent immunoassay (Abbott, US) was used for the quantification of IgG antibodies against the Receptor Binding Domain region of SARS-CoV-2 Spike glycoprotein (anti-RBD IgG) and, simultaneously, a commercial surrogate virus neutralization test (Euroimmun, Germany) was used for the determination of neutralizing antibodies (NAbs). An interferone (IFN)-gamma releasing assay (IGRA test) was used for the evaluation of the T-cellular response (Euroimmun, Germany) after the third vaccine dose. Result(s): Twelve weeks after the third injection of BNT162b2, the median circulating levels of anti-RBD IgG in HD patients and RTx were 5459.5 AU/mL and 961 AU/ mL respectively (p <0.001) and NAbs showed significantly higher values in HD (98%IH) compared with RTx (52% IH). Even the IFN-gamma levels, measured for the evaluation of cellular immunity, were significantly higher in HD (684 mU/mL) than RTx (33 mU/mL) and a significant correlation was found between NAbs and IGRA-test values both in HD (p <0.001) and RTx (p <0.001). Finally, we compared values of anti-RBD IgG and NAbs obtained after the second and the third vaccine doses. Both groups showed significantly higher values after the third dose. Conclusion(s): A great variability in the humoral and cellular response to anti-COVID-19 vaccination was observed in HD and RTx, with a stronger response in the former group. The third dose was globally effective at reinforcing the humoral response in HD and RTx.
ABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic is a worldwide medical challenge due to the scarcity of proper information and remedial resources. The ability to efficiently avoid a further SARS-CoV-2 pandemic will, therefore, depend on understanding several factors which include host immunity, virus behavior, prevention measures, and new therapies. This is a multi-phase observatory study conducted in the SG Moscati Hospital of Taranto in Italy that was converted into COVID-19 Special Care Unit for SARS-Co-V2 risk management. Patients were admitted to the 118 Emergency Pre-Hospital and Emergency Department based on two diagnostic criteria, the nasopharyngeal swab assessed by reverse-transcriptase-polymerase-chain-reaction (RT-PCR) and CT-scan image characterized by ground glass opacity. Patients were divided into four groups, positive-positive (ER-PP), negative-positive (ER-NP), negative-negative (ER-NN) and a group admitted to the ICU (ER-IC). A further control group was added when the T and B lymphocyte subsets were analyzed. Data included gender, age, vital signs, arterial blood gas analysis (ABG), extensive laboratory results with microbiology and bronchoalveolar lavage fluid (BALF) which were analyzed and compared. Fundamental differences were reported among the groups. Males were significantly higher in PP, ICU, and NP groups, from 2 to 4-fold higher than females, while in the NN group, the number of females was mildly higher than males; the PP patients showed a marked alkalotic, hypoxic, hypocapnia ABG profile with hyperventilation at the time of admission; finally, the laboratory and microbiology results showed lymphopenia, fibrinogen, ESR, CRP, and eGFR were markedly anomalous. The total number of CD4+ and CD8+ T cells was dramatically reduced in COVID-19 patients with levels lower than the normal range delimited by 400/µL and 800/µL, respectively, and were negatively correlated with blood inflammatory responses.