Nishioka Ken, Yamaguchi Shintaro, Yasuda Itaru, Yoshimoto Norifumi, Kojima Daiki, Kaneko Kenji, Aso Mitsuhiro, Nagasaka Tomoki, Yoshida Eriko, Uchiyama Kiyotaka, Tajima Takaya, Yoshino Jun, Yoshida Tadashi, Kanda Takeshi, Itoh Hiroshi
Division of Endocrinology, Metabolism and Nephrology, Department of Internal Medicine, Tokyo, Japan.
Apheresis and Dialysis Center, Keio University School of Medicine, Tokyo, Japan.
Front Med (Lausanne). 2022 Apr 8;9:874831. doi: 10.3389/fmed.2022.874831. eCollection 2022.
Since the coronavirus disease 2019 (COVID-19) pandemic continues and a new variant of the virus has emerged, the COVID-19 vaccination campaign has progressed. Rare but severe adverse outcomes of COVID-19 vaccination such as anaphylaxis and myocarditis have begun to be noticed. Of note, several cases of new-onset antineutrophil cytoplasmic antibody-associated vasculitis (AAV) after COVID-19 mRNA vaccination have been reported. However, relapse of AAV in remission has not been recognized enough as an adverse outcome of COVID-19 vaccination. We report, to our knowledge, a first case of renal-limited AAV in remission using every 6-month rituximab administration that relapsed with pulmonary hemorrhage, but not glomerulonephritis, following the first dose of the Pfizer-BioNTech COVID-19 vaccine. The patient received the COVID-19 vaccine more than 6 months after the last dose of rituximab according to the recommendations. However, his CD19 B cell counts were found to be increased after admission, indicating that our case might have been prone to relapse after COVID-19 vaccination. Although our case cannot establish causality between AAV relapse and COVID-19 mRNA vaccination, a high level of clinical vigilance for relapse of AAV especially in patients undergoing rituximab maintenance therapy following COVID-19 vaccination should be maintained. Furthermore, elapsed time between rituximab administration and COVID-19 mRNA vaccination should be carefully adjusted based on AAV disease-activity.
由于2019冠状病毒病（COVID-19）大流行仍在持续，且该病毒出现了新变种，COVID-19疫苗接种工作在不断推进。COVID-19疫苗接种出现了罕见但严重的不良后果，如过敏反应和心肌炎，已开始受到关注。值得注意的是，已有数例COVID-19 mRNA疫苗接种后新发抗中性粒细胞胞浆抗体相关性血管炎（AAV）的病例报告。然而，AAV缓解期复发作为COVID-19疫苗接种的不良后果尚未得到足够认识。据我们所知，我们报告了首例缓解期使用利妥昔单抗每6个月给药一次的肾脏局限性AAV病例，该病例在接种第一剂辉瑞-BioNTech COVID-19疫苗后出现肺出血复发，但未出现肾小球肾炎复发。患者按照建议在最后一剂利妥昔单抗给药6个月后接种了COVID-19疫苗。然而，入院后发现其CD19 B细胞计数增加，表明我们的病例在COVID-19疫苗接种后可能易于复发。虽然我们的病例无法确定AAV复发与COVID-19 mRNA疫苗接种之间的因果关系，但对于AAV复发应保持高度临床警惕，尤其是在COVID-19疫苗接种后接受利妥昔单抗维持治疗的患者中。此外，应根据AAV疾病活动情况仔细调整利妥昔单抗给药与COVID-19 mRNA疫苗接种之间的时间间隔。
