Discussion:
Since the start of the covid-19
vaccination, the temporal association between the vaccine and the
development of de novo or relapse of glomerular diseases, including
anti-GBM, has been studied [4]. However, the pathogenesis of
vaccine-associated glomerular disorders has not been fully elucidated.
On checking the literature, we found a minimal number of reported cases
of de novo anti-GBM disease following COVID-19 vaccine ”in particular
mRNA vaccines” [5,6,7].
Anti-GBM is a rare disease with a bimodal distribution. The majority of
the young patients present with pulmonary manifestations, while most of
the elderly patients present with renal involvement [8.9]. Comparing
our patient to the previously reported cases, all reported cases were
elderly females who presented with hematuria and acute kidney injury
following the COVID-19 vaccine. However, our patient was a young male,
presented with symptomatic pulmonary hemorrhage and renal impairment
simultaneously.
The duration between exposure to the vaccine and the incidence of
anti-GBM disease varied between days to weeks [5,6,7]. At the same
time, its symptoms started two days after the second dose of Moderna
vaccine in our reported patient. Although we were unable to find other
triggers, they cannot be excluded entirely. All reported cases,
including our patient, showed a negative association with Antineutrophil
cytoplasmic antibodies (ANCA). In all patients, the symptoms started
after the second dose of the vaccine, and they were all asymptomatic
after the first dose.
The outcome of the reported cases showed no specific pattern. Despite
receiving steroid cyclophosphamide and plasmapheresis, our patient’s
renal function did not improve, and he remained dialysis-dependent.
Table 1: Cases of De Novo Anti GBM disease post mRNA COVID-19 vaccines