ABSTRACT
Purpose: The aim of this study was to detect infections requiring hospitalization in patients with ANCA-associated vasculitis (AAV).Materials and Methods: This is a single-center, retrospective study conducted in Turkish patients with AAV. Infection episodes requiring hospitalization, reproducing pathogens, laboratory findings, immunosuppressive treatments given for the treatment of vasculitis, and the relationship with the infection were evaluated.Results: Seventy-four patients diagnosed with AAV were included in the study. Hospitalization due to infection was observed in 36 of the patients. The coexistence of diabetes mellitus (DM) was found to be significantly higher in the infected patient group. Cyclophosphamide (CYC) treatment found to increase risk of infection. More than 80% of the infected patient group presented with renal involvement (80.6%). A total of 68 infectious episodes were seen in 36 patients. The most common involvement of infection was the respiratory tract with a rate of 70.6%. Gram-negative bacteria were the most common pathogen, especially Pseudomonas aeruginosa. With the effect of the pandemic, SARS-CoV-2 has come to the fore among viral infections. Aspergillosis was the most frequently detected among fungal infections. Besides, aspergillosis was the cause of 85.7% (6 episodes) of fungal infections. Lymphopenia was observed in 76.5% of the infection episodes. 57.4% of infections developed in the first year of the induction therapy. The most frequently used immunosuppressive therapy for the treatment of vasculitis in infectious episodes was CYC (41.2%).Conclusion: Managing infections during the vasculitis treatment is crucially important. Lymphopenia, kidney involvement, DM and immunosuppressive therapy are factors that increase the risk of infection. Clinicians should take preventive measure especially for respiratory tract infections and gram-negative bacteria as pathogens.
ABSTRACT
CASE: a 29-year-old male presented to the emergency room with diffuse abdominal pain associated with fever and loss of appetite. He received his Moderna COVID-19 booster Vaccine 24 hours before the onset of symptoms. Post-vaccine he had generalized muscle aches, fatigue, and subjective fevers. Examination revealed low grade fever, and diffuse abdominal tenderness. labs showed mild transaminitis (AST>ALT) and an acute kidney injury. His Urinalysis was positive for blood with no RBCs. An Abdominal U/S, CT abdomen and pelvis were unremarkable. A Creatinine Phosphokinase (CPK) was checked as the pattern of AST>ALT elevation, creatinine elevation, and evidence of myoglobinuria were consistent with rhabdomyolysis. CPK was 11,974 U/L. He received aggressive IV hydration, clinically symptoms resolved and CPK trended down before discharge. IMPACT/DISCUSSION: Rhabdomyolysis (RML) is a life threatening clinical syndrome resulting from muscle injury causing muscle breakdown and necrosis which releases intracellular components into the circulation. If missed, RML can lead to acute renal failure. Quite often RML can be caused by viral or bacterial infections. There is a known correlation of COVID-19 causing RML. Most recently there have been 3 published cases of COVID-19 vaccine causing RML. One of the cases resulted in Acute Renal Failure and eventual death of the patient. In our patient a diagnosis of RML was made based on acute abdominal pain that was musculoskeletal in origin, elevated CPK, acute kidney injury, and Transaminitis which is seen in severe RML. Other common causes such as trauma, immobilization, strenuous exercise,medication use, alcohol use, or drug use were ruled out. There was no clear infectious or inflammatory cause identified. His symptoms resolved with aggressive hydration and we had evidence of laboratory improvement of CPK, Creatinine and LFTs. Given that the patient was in good health and the timeline of his COVID-19 booster was followed by muscle aches, fever, abdominal pain combined with resolution of symptoms after treatment, a diagnosis of vaccine- related rhabdomyolysis was made. CONCLUSION: Given the importance of vaccination and the widespread efforts to fight the spread of COVID-19 we strongly encourage everyone to get vaccinated. But despite the high efficacy of the vaccine and its safety, side effects are possible. It is important for physicians to be aware of the potential development of vaccine-induced rhabdomyolysis. We encourage physicians to be attentive to patients' medical history, family history and medication list in an effort to screen for possible risk factors of developing rhabdomyolysis. Patients should be advised to stay hydrated, monitor for symptoms and signs such as muscle aches, weaknesss, and change in color of urine. Prompt identification of vaccine- induced rhabdomyolysis and treatment with aggressive fluid resuscitation can prevent serious complications such as acute renal failure.