Can COVID-19 Vaccination Be the Culprit for New-Onset Crescentic Glomerulonephritis? The Correlation vs. Causation Conundrum

ABSTRACT

Introduction: While the development, delivery, and implementation of the mRNA vaccines have been spectacular, consideration for potential rare side effects on organ systems was not clear. Although emergency use authorization trials of these vaccines in the USA did not demonstrate major safety concerns, unique side effects after massscale vaccination are now being reported more frequently. Here, we describe a case of new-onset crescentic & sclerosing GN with linear basement membrane staining for IgG, kappa, and lambda by Immunofluorescence in a 30-yo healthy female three days after receiving her Tozinameran (Pfizer-BioNTech) booster vaccine. Case Description 30 y/o Caucasian female with no PMH presented with a CC of gross hematuria 3 days after receiving her booster of Tozinameran. Retrospectively reported symptoms of pedal edema, generalized athralgia, tinnitus, and paresthesia of lower limbs. UA revealed dysmorphic RBCs and proteinuria. CT urethrogram, & cystoscopy revealed left hydronephrosis, no nephrolithiasis or urothelial lesions. Kidney biopsy revealed crescentic & sclerosis GN, with linear GBM staining for IgG, Kappa, & Lambda on IF. Several glomeruli showed segmental scars & fibrous crescents in addition to focal cellular crescents of varying ages raising the possibility of concurrent ANCA vasculitis. Her GBM antibody was 25. Additional workup of ANCA, PLA2R, PR3, ana, c3/c4 levels, dsDNA, and hepatitis studies returned negative. On admission, BP was 175/103, and HR 104. Labs were notable for hemoglobin 13.3, WBC 16.6k, & BUN/creatinine 16/1.5. The PE was unremarkable. She received pulse IV steroid therapy, cyclophosphamide, Lupron, and daily plasma exchange (PLEX) for 5 days until her GBM antibody cleared. She responded well to treatment. Her renal function improved, and she was discharged without requiring dialysis. Discussion(s) Our case demonstrates a possible correlation & causation scenario after receiving a Tozinameran booster shot activating anti-GBM disease with concurrent ANCA-negative vasculitis demonstrated by kidney biopsy. Although the mechanism of de novo anti-GBM disease & ANCA-negative vasculitis post-SARS-CoV-2 vaccine remains to be explained, pharmacovigilance is vital in our efforts to ascertain answers.