Otitis Media with ANCA-Associated Vasculitis Following COVID-19 mRNA Vaccination: A Case Report

Abstract

BACKGROUND SARS-CoV-2 caused a worldwide pandemic, and mRNA vaccines against the SARS-CoV-2 spike protein were developed to avoid SARS-CoV-2 infection. Short-term adverse events, such as fever, malaise, body aches, and headaches, develop within a few days following COVID-19 vaccination. Those adverse events are common and widely known as transient reactions. Recently, an association with COVID-19 vaccine as an inducer of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis has been noted. Furthermore, a relationship between COVID-19 vaccination and the development of autoimmune diseases has been reported and termed rheumatoid immune-mediated inflammatory disease. However, the mechanisms of the immune response following COVID-19 vaccination in relation to ANCA-associated vasculitis development remain unclear. CASE REPORT We report a case of a female patient who developed otitis media with ANCA-associated vasculitis following the third dose of COVID-19 mRNA vaccination. A 74-year-old woman presented with bilateral hearing loss and malaise for 1 month after COVID-19 vaccination. Serum myeloperoxidase-ANCA levels were confirmed to be elevated, and pure-tone audiometry revealed moderate bilateral mixed hearing loss. Treatment with steroids and rituximab led to recovery of hearing loss and a reduction in myeloperoxidase-ANCA titre. CONCLUSIONS The pathogenesis of adverse events following COVID-19 vaccination are still unclear. This report has indicated that ANCA-associated vasculitis can be related to COVID-19 mRNA vaccines. As our knowledge of autoimmune disease developing after COVID-19 vaccination is still in the accumulation phase, it is relevant to amass such case reports and use them for assistance in diagnosis in the future.

Figure 1.

Whole-body computed tomography findings. (A) Systematic survey to investigate any malignant or infectious lesions. (B) Surveillance for detecting lung lesions associated with vasculitis. The lung biopsies revealed chronic inflammatory changes (arrows). Vasculitis or hemosiderosis were not found. (C, D) Screening to detect the bony destruction and abnormalities within the tympanic cavity and mastoid cells. No bone destruction was found (arrows).

Figure 2.

Otoscopic examination revealed bilateral middle ear effusions and partial thickening of the eardrums (arrows).

Figure 3.

Audiometric levels as indicated by pure-tone audiometry before and after the treatment. (A) Pure-tone audiometry before the treatment. (B) Pure-tone audiometry 2 months after the treatment initiation.