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Case Reports
. 2022 Nov 4:3:26330040221130084.
doi: 10.1177/26330040221130084. eCollection 2022 Jan-Dec.

'Granulomatosis with polyangiitis after Pfizer vaccination': a case report

Francis Essien  1 , Jordan Evans  2 , Andrew Kyle  3 , Anatoly Urisman  4 , Nicholas Adams  5
Affiliations
Case Reports

'Granulomatosis with polyangiitis after Pfizer vaccination': a case report

Francis Essien et al. Ther Adv Rare Dis. .

Abstract

The advent of COVID-19, caused by the SARS-CoV-2 virus, has resulted in over 541 million cases with 6.32 million deaths worldwide as of June 2022. The devastating consequences of this global pandemic resulted in the expedited generation of mRNA-based vaccines such as the Pfizer-BioNTech and Moderna vaccines. Although the vaccines have been effective, with recent data indicating greater than 95% effectiveness, rare complications have been reported, including manifestations of autoimmune phenomena. Herein, we report a rare case of Granulomatosis with polyangiitis (GPA) in an active duty military male soon after receiving the first dose of the Pfizer-BioNTech COVID-19 vaccine.

Keywords: ANCA vasculitis; COVID-19 Pfizer vaccine; granulomatous with polyangiitis; hemoptysis; pauci-immune glomerulonephritis.

Plain language summary

A 27-year-old active duty marine was admitted to our hospital after being transferred from Hawaii with concern of new autoimmune disease after receiving the Pfizer vaccine. The patient initially presented to the emergency department with joint pain, fever, chest pain, hemoptysis, and a nose bleed. A comprehensive workup demonstrated elevated inflammatory markers, progressive renal dysfunction, and a positive antibody panel consistent with antineutrophil cytoplasmic antibodies (ANCA) vasculitis. Due to the limited capabilities in his deployed setting, he was transferred to our hospital for a higher level of care. We performed some additional tests to include computed tomography (CT) imaging of his lungs and a renal biopsy which came back consistent with GPA. The patient was started on high-dose prednisone and rituximab, and he achieved remission. He was discharged from the hospital with follow-up arranged with rheumatology and nephrology. He remained in remission on follow-up.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Peripheral subpleural consolidation, right greater than left (a) in the setting of confluent centrilobular ground glass opacities with peripheral sparing (b).
Figure 2.
Figure 2.
Biopsy findings: (a) histologic section stained with hematoxylin and eosin reveals blood and red blood cell casts in the tubular lumens. Two glomeruli demonstrate segmental fibrinoid necrosis surrounded by marked hypercellularity suspicious for crescents. Some tubules appear dilated and show features of acute tubular epithelial cell injury. No significant chronic changes are seen (200× magnification). (b) Periodic acid Schiff stain with one of the two glomeruli shown at higher magnification confirms a small crescent with fibrin adjacent to an area of segmental mesangiolysis (400× magnification). (c) Immunofluorescence stain for fibrin highlights a glomerular segment with fibrinoid necrosis (400× magnification). (d) Electron microscopy image shows a distended glomerular capillary lumen with endocapillary hypercellularity adjacent to an area of mesangiolysis and fibrin accumulation (bottom right). Diffuse podocyte foot process effacement is seen (4800× magnification).
See this image and copyright information in PMC

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