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).