Immune-mediated diseases after coronavirus disease 2019 vaccination: rare but important complication

Since the beginning of mass vaccination against coronavirus disease 2019 (COVID-19), vaccine-linked immune-mediated diseases have been increasingly reported. The development of these diseases after COVID-19 vaccination may be attributed to the mechanisms of molecular mimicry and cross-reactivity bet...

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Bibliographic Details
Published in:Croatian medical journal 2022-08, Vol.63 (4), p.389-393
Main Authors: Zagorec, Nikola, Horvatic, Ivica, Senjug, Petar, Horacek, Matija, Ljubanovic, Danica Galesic, Galesic, Kresimir
Format: Article
Language:English
Subjects:
Autoimmune diseases
Case Report
Control
Croatia
Epidemics
Methods
Patient outcomes
Risk factors
Vaccination
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Summary:Since the beginning of mass vaccination against coronavirus disease 2019 (COVID-19), vaccine-linked immune-mediated diseases have been increasingly reported. The development of these diseases after COVID-19 vaccination may be attributed to the mechanisms of molecular mimicry and cross-reactivity between the viral spike protein and self-antigens. The most frequent vaccine-linked glomerular disease is immunoglobulin A nephropathy (IgAN). Cutaneous vasculitis has also been reported after COVID-19 vaccination. In both diseases, deposition of immune complexes activates the inflammatory response with end-organ damage. We report on a case of de novo IgAN in a young man and a case of severe cutaneous vasculitis in a 68-year-old woman, both after the second dose of Pfizer-BioNTech COVID-19 vaccine. Neither of the patients had a history of autoimmunity or adverse reactions to vaccines. The temporal association between vaccination and disease development in the absence of other possible intercurrent inciting events suggests a causal mechanism, although coincidental co-occurrence cannot be excluded. In both cases, immunosuppressive treatment was warranted to stop disease progression and to partially or completely resolve the disease. A timely reaction is needed if new-onset signs of an immune-mediated disease appear after vaccination.
ISSN:0353-9504
1332-8166
DOI:10.3325/cmj.2022.63.389