Dual-Positive MPO- and PR3-ANCA-Associated Vasculitis Following SARS-CoV-2 mRNA Booster Vaccination: A Case Report and Systematic Review

• Published in: Vaccines (Basel) 2022-04, Vol.10 (5), p.653
• Main Authors: Baier, Eva, Olgemöller, Ulrike, Biggemann, Lorenz, Buck, Cordula, Tampe, Björn
• Format: Article
• Language: English
• Subjects: ANCA-associated vasculitis; Antibodies; Antigens; Antineutrophil cytoplasmic antibodies; Autoantibodies; Binding sites; booster vaccination; Case reports; Cell surface; Coronaviruses; COVID-19; COVID-19 vaccines; Disease control; Drug dosages; Epidemics; Granulomatosis; Hemorrhage; Herd immunity; Histocompatibility antigen HLA; Immune response; Immune system; Inflammation; Influenza; Leukocytes; Major histocompatibility complex; Monocytes; mRNA; mRNA vaccines; Pandemics; Pathophysiology; Patients; Peroxidase; Proteinase; Proteinase 3; pulmonary hemorrhage; Receptors; Respiratory diseases; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Steroids; Surveillance; Systematic Review; systemic vasculitis; T cell receptors; Vaccines; Vasculitis; Vectors (Biology); Viral diseases
• ISSN: 2076-393X; 2076-393X
• DOI: 10.3390/vaccines10050653

As the coronavirus disease 2019 (COVID-19) pandemic is ongoing, and new variants of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) are emerging, vaccines are needed to protect individuals at high risk of complications and to potentially control disease outbreaks by herd immunity. After SARS-CoV-2 vaccination, antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) presenting with a pulmonary hemorrhage has been described. Previous studies suggested that monocytes upregulate major histocompatibility complex (MHC) II cell surface receptor human leukocyte antigen receptor (HLA-DR) molecules in granulomatosis with polyangiitis (GPA) patients with proteinase 3 (PR3)- and myeloperoxidase (MPO)-ANCA seropositivity. Here, we present a case of new-onset AAV after booster vaccination with the Pfizer-BioNTech SARS-CoV-2 mRNA vaccine. Moreover, we provide evidence that the majority of monocytes express HLA-DR in AAV after SARS-CoV-2 booster vaccination. It is possible that the enhanced immune response after booster vaccination and presence of HLA-DR monocytes could be responsible for triggering the production of the observed MPO- and PR3-ANCA autoantibodies. Additionally, we conducted a systematic review of de novo AAV after SARS-CoV-2 vaccination describing their clinical manifestations in temporal association with SARS-CoV-2 vaccination, ANCA subtype, and treatment regimens. In light of a hundred million individuals being booster vaccinated for SARS-CoV-2 worldwide, a potential causal association with AAV may result in a considerable subset of cases with potential severe complications.