Autoimmune hemolytic anemia following SARS-COV- 2 vaccine in SLE nephritis with coexistent thymoma, complicated by severe COVID-19 infection
International Journal of Rheumatic Diseases
; 26(Supplement 1):342.0, 2023.
Article
in English
| EMBASE | ID: covidwho-2236356
ABSTRACT
Background:
We report a 40-year- old female with co-existent lupus nephritis and thymoma who developed severe lupus flare (worsening nephritis, new onset hemolytic anemia) following SARS-CoV- 2 vaccine. Case This 40 year old female has had stable lupus nephritis (LN) while maintained on mycophenolate mofetil and hydroxychloroquine for several years. A co-existent thymoma was likewise stable and did not require any added therapy apart from the management of the LN. She received the first dose of inactivated vaccine for SARS-CoV- 2 without event. Two weeks following the second dose, she developed Coombs positive hemolytic anemia (hemoglobin 64 g/L) with leukopenia (WBC 2.3 x 109/L), worsening nephritis (3+ proteinuria with uPCR 1.0, active urine sediments), hypocomplementemia, and elevated anti-dsDNA. She received methylprednisolone pulse therapy then maintained on prednisone 40mg/day with clinical improvement. Two weeks thereafter, she was admitted due to severe COVID-19 pneumonia accompanied by severe anemia requiring blood transfusion;she received a regimen of bevacizumab, dexamethasone, and remdesivir and was discharged recovered, without overt sequelae at the time of this report. Discussion(s) Vaccines are highly effective in reducing hospitalization and death attributable to SARS-CoV- 2 infection. There are concerns however regarding autoimmune disease flares following SARS-CoV- 2 vaccine, reported to occur in about 4% patients with autoimmune disorders. It is also possible that this patient's reaction may have been further aggravated by the co-existent thymoma. While there was apparent sub-optimal protection of the vaccine against moderate to severe COVID-19 infection in this patient, it may be conjectured that her significant recovery and response to the anti-viral combined with immunosuppressive regimen may be due to the high dose steroid treatment given for the post-vaccine autoimmune reaction.
adult; adverse drug reaction; anemia; autoimmune disease; autoimmune hemolytic anemia; blood transfusion; case report; clinical article; complication; conference abstract; Coombs positive hemolytic anemia; coronavirus disease 2019; disease exacerbation; drug combination; drug megadose; drug therapy; female; hospitalization; human; hypocomplementemia; leukopenia; lupus erythematosus nephritis; nephritis; nonhuman; proteinuria; Severe acute respiratory syndrome coronavirus 2; side effect; systemic lupus erythematosus; thymoma; urine sediment; antivirus agent; bevacizumab; dexamethasone; endogenous compound; hemoglobin; hydroxychloroquine; inactivated vaccine; methylprednisolone; mycophenolate mofetil; prednisone; remdesivir; SARS-CoV-2 vaccine
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Prognostic study
Topics:
Long Covid
/
Vaccines
Language:
English
Journal:
International Journal of Rheumatic Diseases
Year:
2023
Document Type:
Article
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