Sugiura Takuya, Doke Tomohito, Tanaka Akihito, Sato Yuka, Maeda Kayaho, Furuhashi Kazuhiro, Kato Noritoshi, Kosugi Tomoki, Maruyama Shoichi
Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
CEN Case Rep. 2025 Apr;14(2):194-199. doi: 10.1007/s13730-024-00927-6. Epub 2024 Sep 19.
A 75-year-old man presented with MPO-ANCA-positive rapidly progressive glomerulonephritis after COVID-19 vaccination during the treatment of plaque psoriasis vulgaris with bimekizumab. Bimekizumab, an anti-IL17 monoclonal antibody, was regularly administered to control the activity of plaque psoriasis. After receiving the sixth COVID-19 vaccine, his kidney function rapidly declined over the course of weeks. Urinalysis showed microscopic hematuria and proteinuria with deformed red blood cells and granular cast. The immunology test was positive for MPO-ANCA. The patient was clinically diagnosed with MPO-ANCA-associated glomerulonephritis. As the patient lost his appetite and developed lower extremity edema with low eGFR (< 15 ml/min/1.73m) on admission day, hemodialysis induction was initiated along with methylprednisolone pulse, followed by oral prednisolone. The kidney function and urine volume were improved in response to immunosuppressive therapy, and withdrawal from hemodialysis was considered. However, the patient developed a catheter infection due to methicillin-sensitive Staphylococcus aureus 2 weeks after the initial prednisolone treatment, causing a decline in kidney function. Antibiotics treatment for the catheter infection was effective, but kidney function remained low, resulting in dependence on regular hemodialysis. COVID-19 vaccination provides significant improvement in overall prognosis; however, there have been reports of kidney function decline and exacerbation of hematuria in patients with IgA nephropathy following vaccination. The incidence of MPO-ANCA-associated glomerulonephritis after COVID-19 vaccination was rare. Data accumulation is warranted to understand the risk factors for secondary MPO-ANCA glomerulonephritis after COVID-19 vaccination. Regular monitoring of urinalysis and kidney function after COVID-19 vaccination is recommended in patients with psoriasis vulgaris treated with IL17 monoclonal antibodies.
一名75岁男性在使用比美吉珠单抗治疗寻常型斑块状银屑病期间接种新冠疫苗后，出现了MPO-ANCA阳性的快速进展性肾小球肾炎。比美吉珠单抗是一种抗IL-17单克隆抗体，定期给药以控制斑块状银屑病的活动。在接种第六剂新冠疫苗后，他的肾功能在数周内迅速下降。尿液分析显示镜下血尿和蛋白尿，伴有变形红细胞和颗粒管型。免疫学检查MPO-ANCA呈阳性。该患者临床诊断为MPO-ANCA相关性肾小球肾炎。入院当天，由于患者食欲不振且出现下肢水肿，估算肾小球滤过率低（<15 ml/min/1.73m²），开始进行血液透析诱导治疗，并给予甲泼尼龙冲击治疗，随后口服泼尼松龙。免疫抑制治疗后肾功能和尿量有所改善，考虑停止血液透析。然而，在最初使用泼尼松龙治疗2周后，患者因甲氧西林敏感金黄色葡萄球菌发生导管感染，导致肾功能下降。导管感染的抗生素治疗有效，但肾功能仍然较低，导致依赖定期血液透析。接种新冠疫苗可显著改善总体预后；然而，有报道称IgA肾病患者接种疫苗后出现肾功能下降和血尿加重。新冠疫苗接种后MPO-ANCA相关性肾小球肾炎的发病率罕见。有必要积累数据以了解新冠疫苗接种后继发性MPO-ANCA肾小球肾炎的危险因素。对于接受IL-17单克隆抗体治疗的寻常型银屑病患者，建议在接种新冠疫苗后定期监测尿液分析和肾功能。
