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