Introduction:
The novel coronavirus 2019 (COVID-19) pandemic that has been causing
striking worldwide extensive morbidity and mortality during the past two
years was followed by heroic research and vaccine discoveries, altering
the course of the illness in a more benign direction. The worldwide
vaccination campaigns are of clear benefit. Still, adverse events that
were not previously observed during clinical trials are now sprouting
and should remain in focus and must be tracked and followed up
vigilantly. Interestingly, there has been an upward trend in reporting
cases of unmasking/reactivation of glomerular disease after receiving
mRNA vaccines.
Antiglomerular basement membrane (anti-DBM) disease is an autoimmune
vasculitis disease characterized by the production of autoantibodies
against type IV collagen present in basement membranes affecting both
kidneys and lungs. These autoantibodies cause capillaritis at the
mentioned sites, and patients usually succumb to rapidly progressive
glomerulonephritis and alveolar bleeding. Diagnosis is made by linking
clinical data and serologic testing, though renal biopsy is required for
confirmation [1]. Like most autoimmune diseases, anti-GBM disease
occurs in genetically predisposed individuals after a specific insult
such as an infection, drugs, environmental exposure, etc. [2].
During the COVID era, accelerated vaccine production has been observed.
The different vaccines use different mechanisms to generate immunity.
Pfizer BNT162b2 and Moderna mRNA-1273 use a pioneer mechanism, a lipid
nanoparticle nucleoside-modified mRNA encodes SARS-CoV-2 spike (S)
protein which medicates host attachment and viral entry. AstraZeneca
uses a replication-deficient chimpanzee adenovirus vector containing the
SARS-CoV-2 S protein. It has been shown recently that vaccines,
specifically mRNA-based ones, are linked to the development of
glomerular disease [3].
Case Report/Case Presentation
We are presenting a 26 years old male, previously healthy, working as a
labor in a building company. The patient was sent on 16th August 2021 to
our medical department from a field hospital complaining of cough,
hemoptysis, shortness of breath, and feeling fatigued for seven days
which increased in severity in the last two days. He mentioned no chest
pain or fever. On further questioning, he said he received the COVID-19
vaccine (Moderna) second dose on 14th August, while the first was given
on 17th July. Currently, he doesn’t smoke, consume alcohol, or take any
medications. On examination, the patient looked in mild respiratory
distress. His vital signs showed a respiratory rate of 23 cycles/min,
pulse rate of 98 beats/min, and Blood pressure of 115/76 mmHg. He was
afebrile, and his Oxygen saturation was 96% on room air. Chest
examination was significant for diffuse bilateral crackles with
scattered wheezes. Cardiovascular, abdomen, and neurologic exams were
unremarkable. The patient was started on salbutamol nebulization while
blood tests and chest X-rays were requested.
Initial lab results were significant for a Hemoglobin (Hb) of 5.6 gm/dl;
platelets count was 231,000/mcl; blood urea was 15 mmol/l; creatinine
was 641umol/l; potassium was 4.1 mmol/l, and bicarbonate was 18 mmol/l.
The chest X-ray showed bilateral diffuse airspace opacity and patchy
consolidative changes at both lung parenchyma with background lung
nodular shadow (Figure 1).