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mRNA 疫苗接种引发的非典型溶血尿毒综合征:病例报告。

Atypical hemolytic uremic syndrome triggered by mRNA vaccination against SARS-CoV-2: Case report.

机构信息

Department of Nephrology, First Faculty of Medicine, General University Hospital, Charles University, Prague, Czechia.

University Hospital, Charles University - Faculty of Medicine, Hradec Králové, Czechia.

出版信息

Front Immunol. 2022 Sep 28;13:1001366. doi: 10.3389/fimmu.2022.1001366. eCollection 2022.


DOI:10.3389/fimmu.2022.1001366
PMID:36275662
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9580272/
Abstract

Atypical hemolytic uremic syndrome (aHUS), also called complement-mediated hemolytic uremic syndrome (CM-HUS), is a rare disease caused by dysregulation in the alternative complement activation pathway. It is a life-threatening condition causing ischemia of a number of organs, and it typically causes acute kidney injury. This disorder may be triggered by various factors including viral or bacterial infections, pregnancy, surgery, and injuries. In about 60% of cases, the genetic origin of the disease can be identified-commonly mutations affecting complementary factor H and MCP protein. Eculizumab, a monoclonal antibody to the C5 component of the complement, represents the current effective treatment.We describe a case of a young woman with a previous history of polyvalent allergies, who developed atypical hemolytic uremic syndrome after vaccination with mRNA vaccine against SARS-CoV-2. The disease manifested by scleral bleeding, acute renal insufficiency, anemia, and thrombocytopenia. The patient was treated with without sufficient effect; remission occurred only after starting treatment with eculizumab. Genetic examination showed that the patient is a carrier of multiple inherited risk factors (a rare pathogenic variant in , MCPggaac haplotype of the gene, and the risk haplotype H3). The patient is currently in hematological remission with persistent mild renal insufficiency, continuing treatment with eculizumab/ravulizumab. By this case report, we meant to point out the need for careful monitoring of people after vaccination, as it may trigger immune-mediated diseases, especially in those with predisposing factors.

摘要

非典型溶血尿毒症综合征(aHUS),也称补体介导的溶血尿毒症综合征(CM-HUS),是一种由替代补体激活途径失调引起的罕见疾病。它是一种危及生命的疾病,可导致多个器官缺血,通常会导致急性肾损伤。这种疾病可能由多种因素引发,包括病毒或细菌感染、妊娠、手术和外伤等。约 60%的病例可以确定疾病的遗传起源,常见的突变影响补体因子 H 和 MCP 蛋白。依库珠单抗,一种针对补体 C5 成分的单克隆抗体,是目前有效的治疗方法。我们描述了一例年轻女性,有多种过敏的既往病史,在接种 SARS-CoV-2 mRNA 疫苗后发生非典型溶血尿毒症综合征。疾病表现为巩膜出血、急性肾功能不全、贫血和血小板减少。该患者接受了 治疗,但效果不佳;仅在开始使用依库珠单抗治疗后才缓解。基因检查显示该患者是多种遗传风险因素的携带者(罕见的致病性变异在 基因中,MCPggaac 基因的单倍型,以及风险单倍型 H3)。该患者目前处于血液学缓解期,但持续存在轻度肾功能不全,继续接受依库珠单抗/拉维珠单抗治疗。通过本病例报告,我们旨在指出需要仔细监测接种后的人群,因为疫苗接种可能会引发免疫介导的疾病,尤其是在有易感因素的人群中。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f43/9580272/91aab2fd3ffe/fimmu-13-1001366-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f43/9580272/66a7b83f093a/fimmu-13-1001366-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f43/9580272/9623d569aea8/fimmu-13-1001366-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f43/9580272/91aab2fd3ffe/fimmu-13-1001366-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f43/9580272/66a7b83f093a/fimmu-13-1001366-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f43/9580272/9623d569aea8/fimmu-13-1001366-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f43/9580272/91aab2fd3ffe/fimmu-13-1001366-g003.jpg

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[1]
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[2]
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[4]
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[7]
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[8]
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引用本文的文献

[1]
Atypical Hemolytic Uremic Syndrome Associated with BNT162b2 mRNA COVID-19 Vaccine in a Kidney Transplant Recipient: A Case Report and Literature Review.

Infect Dis Rep. 2025-2-11

[2]
Aplastic Anemia Following COVID-19 Vaccination: A Systematic Review of Case Reports and Case Series.

Int J Hematol Oncol Stem Cell Res. 2024-7-1

[3]
Safety of COVID-19 Vaccination in Pregnancy: A Systematic Review.

Diagnostics (Basel). 2024-8-14

[4]
Atypical hemolytic-uremic syndrome after COVID-19 vaccine: A case report.

Immun Inflamm Dis. 2024-7

[5]
A Rare Case of Autoimmune Disorder as a Trigger for Atypical Hemolytic Uremic Syndrome.

Cureus. 2024-1-28

[6]
End stage renal disease in patient with microscopic polyangiitis and atypical hemolytic-uremic syndrome arose 3 weeks after the third dose of anti-SARS-CoV2 vaccine mRNA-1273: A case report with literature revision.

Medicine (Baltimore). 2023-12-15

[7]
The Rationale of Complement Blockade of the MCP Haplotype following Atypical Hemolytic Uremic Syndrome of Three Southeastern European Countries with a Literature Review.

Int J Mol Sci. 2023-8-22

[8]
Eculizumab discontinuation in a patient with atypical hemolytic uremic syndrome after ChAdOx1 nCoV-19 vaccination.

Clin Nephrol Case Stud. 2023-7-13

[9]
Immunologic and Genetic Contributors to CD46-Dependent Immune Dysregulation.

J Clin Immunol. 2023-11

[10]
Complement-Mediated Thrombotic Microangiopathy Related to COVID-19 or SARS-CoV-2 Vaccination.

Kidney Int Rep. 2023-5-22

本文引用的文献

[1]
Complement Levels at Admission Reflecting Progression to Severe Acute Kidney Injury (AKI) in Coronavirus Disease 2019 (COVID-19): A Multicenter Prospective Cohort Study.

Front Med (Lausanne). 2022-4-29

[2]
Case Report: A Case of COVID Vaccine-Induced Thrombotic Thrombocytopenia Manifested as Pulmonary Embolism and Hemorrhagia. A First Reported Case From Slovakia.

Front Med (Lausanne). 2022-1-4

[3]
Atypical Hemolytic Uremic Syndrome after ChAdOx1 nCoV-19 Vaccination in a Patient with Homozygous CFHR3/CFHR1 Gene Deletion.

Nephron. 2022

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A case of ANCA-associated vasculitis after AZD1222 (Oxford-AstraZeneca) SARS-CoV-2 vaccination: casualty or causality?

Kidney Int. 2021-10

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Relapse of class V lupus nephritis after vaccination with COVID-19 mRNA vaccine.

Kidney Int. 2021-10

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Kidney Int. 2021-10

[7]
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Kidney Int. 2021-10

[8]
A case of membranous nephropathy following Pfizer-BioNTech mRNA vaccination against COVID-19.

Kidney Int. 2021-10

[9]
Vaccine-induced immune thrombotic thrombocytopenia: what we know and do not know.

Blood. 2021-7-29

[10]
Prothrombotic immune thrombocytopenia after COVID-19 vaccination.

Blood. 2021-7-29

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