Several case reports indicate the COVID vaccines may be associated with vasculitis, a condition that inflames and damages blood vessels.
Various diseases associated with COVID-19 vaccines have been reported. A recent case study indicated that COVID-19 vaccination may trigger the development of anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis, potentially damaging multiple organs. Among 29 patients, five underwent plasmapheresis treatment (the separation and replacement of plasma from blood), and five relied on dialysis therapy.
ANCA-associated vasculitis can cause damage to small blood vessels.
Since these are distributed throughout the body, any part of the body can be affected, with the most common areas being the lungs, kidneys, joints, ears, nose, and nerves.
Neutrophils are a type of white blood cell that aids the body in fighting infection and healing injuries. ANCA are harmful autoantibodies that bind to neutrophils in the blood, releasing toxic substances and damaging the walls of small blood vessels. This can also result in the migration of neutrophils through blood vessel walls, inducing inflammation in the surrounding tissues. Additionally, it releases signaling factors that attract even more neutrophils, perpetuating inflammation and further damaging small blood vessels.
Case Report of ANCA-Associated Vasculitis
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case report published in Case Reports in Nephrology in April 2023 detailed an 82-year-old woman with high blood pressure who, after receiving her third booster COVID-19 vaccine booster, developed myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA)-associated vasculitis. MPO-ANCA is one of the primary autoantibodies in ANCA-associated vasculitis.
The patient received two doses of the Pfizer vaccine in May and June 2021, followed by a Moderna booster shot in early February 2022. The next day after the booster shot, she experienced a headache, which subsided after three days. However, starting in early March, her body temperature began to rise, accompanied by general malaise.
Upon examination, no apparent bacterial infection was found, but blood tests revealed an inflammatory reaction. The C-reactive protein level was elevated, and her white blood cell count was 13,000/microliters (the normal range is between 4,000 and 10,000/microliters), suggesting a bacterial infection. The doctor prescribed antibiotics for seven consecutive days, but there was no improvement.
The patient was later admitted to the hospital. Physical examination and imaging tests did not reveal fever, and kidney size and structure appeared normal. However, microscopic analysis uncovered hematuria (blood in the urine) and urinary protein. Additionally, the MPO-ANCA level was notably high. A kidney biopsy revealed cellular crescents in six glomeruli—the tiny filters inside the kidneys—and mild inflammation.
Furthermore, immunofluorescence confirmed
pauci-immune glomerulonephritis. This is a rare small vessel vasculitis associated with rapidly progressive glomeruli inflammation, clinically characterized by kidney issues such as urinary abnormalities (hematuria and proteinuria) and high blood pressure resulting in kidney failure within days or weeks. Based on the pathological findings, the patient was diagnosed with renal-limited MPO-ANCA-associated vasculitis.
The patient was put on a steroid medication, and symptoms such as fever, malaise, and inflammatory reaction improved, while both hematuria and urinary protein disappeared. The doctor gradually reduced the steroid dosage, cutting it in half, and the patient’s condition stabilized.
The researchers stated that blood and urine tests conducted on the patient before her third vaccine dose did not reveal kidney damage or abnormalities, suggesting an association between the COVID-19 vaccine and the onset of MPO-ANCA-associated vasculitis.
The researchers suggested that the possibility of MPO-ANCA-associated vasculitis should be considered for patients experiencing fever, prolonged general malaise, hematuria, or kidney impairment after receiving a COVID-19 mRNA vaccine, especially Moderna, as was the case with this patient.
5 COVID-19 Vaccines Related to ANCA-Associated Vasculitis
An increasing number of reports indicate that widespread vaccination has led to the development of vasculitis in some people, resulting in damage to multiple organs.
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case-based review reported five types of COVID-19 vaccines linked to ANCA-associated vasculitis.
The study included cases from 29 patients, with 22 receiving mRNA vaccines (Moderna and Pfizer), four receiving AstraZeneca, two receiving Covaxin, and one receiving Johnson & Johnson. They all exhibited symptoms of ANCA-associated vasculitis after receiving one of these COVID-19 vaccines.
Specifically, 22 patients exhibited kidney damage, manifested as new-onset or recurrent glomerulonephritis. At least 24 individuals presented with hematuria. Ten experienced lung damage, with five cases involving alveolar hemorrhage. One person developed optic neuritis, and another had auricular chondritis. These are manifestations of organ damage following vaccine administration.
Most patients received immunosuppressive treatment, including steroid medications. Additionally, five underwent plasma exchange, and at least five patients continued to rely on dialysis at the last follow-up.
The study mentioned that mRNA vaccines may stimulate myeloid and dendritic cells to varying degrees, activating downstream pathways to generate autoinflammation. Furthermore, mRNA vaccines generate antiviral-neutralizing antibodies and activate CD8+ and CD4+ T cells, triggering strong immune responses. Compared to natural infection, mRNA vaccines may enhance innate and acquired immunity stimulation. In some individuals with compromised immune systems, the ability to clear nucleic acids may decrease, potentially impacting neutrophils.
Vasculitis May Lead to Multiorgan Damage
There are different types of ANCA-associated vasculitis, including microscopic polyangiitis, where the frequency of MPO-ANCA positivity is notably high.
According to data from the
Japan Intractable Diseases Information Center, approximately 70 percent of patients with microscopic polyangiitis experience systemic symptoms, including fever, weight loss, and fatigue. Additionally, symptoms such as hemorrhage, ischemia, or infarction in body tissues may occur.
Necrotizing glomerulonephritis is the most common, presenting with symptoms like hematuria, protein in urine, and elevated serum creatinine. Early diagnosis is crucial, as the condition often progresses rapidly to kidney failure within weeks to months. Other prevalent manifestations include rash, with livedo reticularis, purpura, skin ulcers, and subcutaneous nodules in approximately 60 percent of patients with necrotizing glomerulonephritis. Polyneuropathy is observed in about 60 percent, joint pain in around 50 percent, and muscle pain in roughly 50 percent of cases.
Additionally, interstitial pneumonia is seen in approximately 25 percent, and alveolar hemorrhage in about 10 percent. Both conditions are attributed to vasculitis affecting the pulmonary capillaries, leading to cough, shortness of breath, rapid breathing, coughing up blood, bloody sputum, and severely low blood oxygen levels. Gastrointestinal involvement occurs in around 20 percent of cases, and myocardial involvement resulting in heart failure occurs in approximately 18 percent.
ANCA-associated vasculitis can be life-threatening if not promptly treated. Early diagnosis and appropriate treatment lead to improvement in the majority of cases. However, delayed treatment or poor response to initial therapy may result in irreversible organ dysfunction, necessitating procedures such as blood dialysis for patients experiencing kidney failure. Moreover, due to the possibility of symptom recurrence, patients should undergo regular checkups with specialists.
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