Yadav Rukesh, Shah Sangam, Chhetri Santosh
Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Maharajgunj, 44600, Nepal.
Department of Nephrology, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Maharajgunj, 44600, Nepal.
Ann Med Surg (Lond). 2022 Jul;79:104123. doi: 10.1016/j.amsu.2022.104123. Epub 2022 Jul 5.
Antineutrophil cytoplasmic autoantibodies associated vasculitis (AAV) is characterized by antibodies against antigens in cytoplasmic granules of neutrophils and predominantly affects small vessels. AAV after COVID-19 mRNA vaccination has been reported.
We report a rare case of AAV in a patient who presented with rapidly progressive glomerulonephritis (RPGN) after Johnson & Johnson COVID-19 vaccine administration.
The temporal causal association between autoimmune manifestations like AAV and COVID-19 vaccines can be explained by hypothesized mechanisms like molecular mimicry, defective neutrophilic apoptosis, polyclonal activation, and systemic proinflammatory cytokine response. These mechanisms are likely to trigger autoimmune responses in genetically susceptible individuals. Still there are many research going on to fill the research gap on the development of ANCA associated with COVID-19 vaccines.
Increasing reports of rare adverse effects like AAV following COVID-19 vaccination warrants the further study and evaluation of immune responses induced by those vaccines. Considering the potential severity of COVID-19 and the rarity of the above-mentioned adverse effects, COVID-19 vaccination should not be withheld.
抗中性粒细胞胞浆自身抗体相关血管炎(AAV)的特征是存在针对中性粒细胞胞浆颗粒中抗原的抗体,主要累及小血管。已有关于新冠病毒mRNA疫苗接种后发生AAV的报道。
我们报告了1例在接种强生公司新冠病毒疫苗后出现快速进展性肾小球肾炎(RPGN)的AAV罕见病例。
AAV等自身免疫表现与新冠病毒疫苗之间的时间因果关联可通过分子模拟、中性粒细胞凋亡缺陷、多克隆激活和全身促炎细胞因子反应等假设机制来解释。这些机制可能在遗传易感个体中引发自身免疫反应。目前仍有许多研究在进行,以填补与新冠病毒疫苗相关的抗中性粒细胞胞浆抗体(ANCA)研究空白。
新冠病毒疫苗接种后出现AAV等罕见不良反应的报道增多,有必要进一步研究和评估这些疫苗诱导的免疫反应。鉴于新冠病毒的潜在严重性以及上述不良反应的罕见性,不应停止接种新冠病毒疫苗。