Clinical Images: Severe proteinase 3 antineutrophil cytoplasmic antibody glomerulonephritis temporally associated with Sinovac Biotech’s inactivated SARS‐CoV‐2 vaccine

• Published in: ACR Open Rheumatology Vol. 4; no. 4; pp. 277 - 278
• Main Authors: Garcia, Diego Santos, Martins, Cássio, Fonseca, Elissa Oliveira, Carvalho, Victor Côrtes Pourchet, Rezende, Rodrigo Poubel Vieira
• Format: Journal Article Web Resource
• Language: English
• Published: Boston, USA Wiley Periodicals, Inc 01.04.2022; John Wiley & Sons, Inc; Wiley
• Subjects: Biopsy; Clinical Image; Coronaviruses; COVID-19 vaccines; Immunization; Severe acute respiratory syndrome coronavirus 2; Steroids
• ISSN: 2578-5745; 2578-5745
• DOI: 10.1002/acr2.11397

[...]she had leukocytosis, anemia, thrombocytosis, elevated inflammatory biomarkers and serum creatinine (peak at 7.3 vs 0.8 mg/dl on May 1, 2021), cytoplasmic ANCA 1:20 by indirect immunofluorescence (reference: negative), an anti-proteinase-3 level of 19 U/ml by fluorescent-enzyme immunoassay (positive >3 U/ml), a normal complement level, polyclonal hypergammaglobulinemia, and active urinary sediment. The diagnostic workup was negative for COVID-19 (reverse transcription–polymerase chain reaction), antinuclear antibodies (ANA), rheumatoid factor, cryoglobulins, anti-myeloperoxidase, anti-phospholipids, anti-Ro, anti-La, anti-Smith (Sm), anti–double-stranded DNA, anti-ribonucleoprotein (RNP), anti–glomerular basement membrane, HIV, and hepatitis B and C. Computed tomography (head, chest, paranasal sinuses, and abdomen), echocardiography, and nasal and laryngeal videoendoscopy findings were either normal or nonspecific. The renal biopsy specimen shows a cellular crescent and break of the glomerular basement membrane (periodic acid–Schiff stain, original magnification ×40) (A), break in Bowman’s capsule (Jones stain, original magnification ×40) (B), an acute tubular injury (hematoxylin–eosin stain, original magnification ×40) (C), and fibrinoid necrosis in the glomerulus capillary loop (hematoxylin–eosin stain, original magnification ×40) (D).