Thammathiwat Theerachai, Banjongjit Athiphat, Chumnumsiriwath Piyatida, Chompuk Laor, Sripariwuth Apichaya, Pongcharoen Sutatip, Kanjanabuch Talerngsak
Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok 65000, Thailand.
Nephrology Unit, Department of Medicine, Vichaiyut Hospital, Bangkok 10400, Thailand.
Vaccines (Basel). 2022 Nov 9;10(11):1888. doi: 10.3390/vaccines10111888.
We report an unusual case of nephrotic syndrome and multiple venous thromboembolism (VTE) four days after BNT162b2 injection. The patient presented with a three-day history of foamy urine and one-day history of right leg swelling. The investigation showed 9.5 g of 24 hr urine protein, hypoalbuminemia (2.6 gm/dL), and hypercholesterolemia (320 mg/dL). The duplex ultrasonography revealed VTE of the right lower extremity veins (common femoral vein, saphenous vein, and popliteal vein). Computed tomography (CT) showed thrombosis of the infrarenal inferior vena cava (IVC) extending to both iliac veins and acute pulmonary embolism. Kidney biopsy was performed. The diagnosis of minimal change disease was made. The patient received anticoagulation without steroid or immunosuppressive medications. The nephrosis was spontaneously resolved in 20 days; thus, it strongly suggested the diagnosis of vaccine-induced minimal change nephropathy. Reports of kidney adverse events and clinical characteristics are further needed in the circumstances of worldwide SARS-CoV-2 vaccine usage.
我们报告了一例在注射BNT162b2疫苗四天后出现肾病综合征和多发性静脉血栓栓塞（VTE）的罕见病例。患者有三天泡沫尿病史和一天右腿肿胀病史。检查显示24小时尿蛋白9.5克、低白蛋白血症（2.6克/分升）和高胆固醇血症（320毫克/分升）。双功超声检查显示右下肢静脉（股总静脉、大隐静脉和腘静脉）发生VTE。计算机断层扫描（CT）显示肾下腔静脉（IVC）血栓形成并延伸至双侧髂静脉以及急性肺栓塞。进行了肾活检。诊断为微小病变病。患者接受了抗凝治疗，未使用类固醇或免疫抑制药物。肾病在20天内自行缓解；因此，强烈提示为疫苗诱导的微小病变肾病。在全球使用SARS-CoV-2疫苗的情况下，还需要进一步了解肾脏不良事件的报告和临床特征。
