After a kidney biopsy, she was diagnosed with ANCA-associated pauci-immune crescentic glomerulonephritis. succinate for 3 days) followed by a reduced steroid routine. Keywords: ANCA-Vasculitis, Heterologous, mRNA1273 COVID-19 Vaccine Graphical Abstract Intro There have been shreds of evidence about NQDI 1 coronavirus disease 2019 (COVID-19) vaccines that can trigger antibody production through activation of T helper cells.1 The mRNA vaccines appear to induce autoimmune diseases in vulnerable individuals by activating the production and secretion of proinflammatory cytokines.1 There have been case reports and evaluations about the causality of various vaccines and autoimmune diseases, however, no definite relationship with vaccines has been clearly elucidated.2 Although further studies should be continued, it was identified that myeloperoxidase (MPO) titer has been increased after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) illness inside a pilot study.3 Despite that the immune responses after natural infection with SARS-CoV-2 and mRNA vaccination could differ, there have been issues about antineutrophil cytoplasmic antibody Rabbit polyclonal to Synaptotagmin.SYT2 May have a regulatory role in the membrane interactions during trafficking of synaptic vesicles at the active zone of the synapse. (ANCA) vasculitis after COVID-19 vaccines.4 CASE DESCRIPTION A 72-year-old female with no specific past medical history presented with tinnitus, nasal congestion, and bloody rhinorrhea. Her constitutional symptoms developed after she received the first dose of the ChAdOx1 nCoV-19 (Oxford AstraZeneca) COVID-19 vaccine NQDI 1 on 12 July 2021, and her symptoms were aggravated after she received the second dose of the ChAdOx1 nCoV-19 vaccine on 16 August. She underwent tympanostomy tube insertion and received antibiotic therapy for 2 weeks. However, after she received her third (booster) dose, the mRNA1273 (Moderna) vaccine, on 28 December 2021, she experienced anorexia, abdominal pain, and NQDI 1 febrile sensation. Consequently, she was admitted to the gastroenterology division of our hospital. Her endoscopic findings exposed erosive gastritis, and she was treated with intravenous hydration because of her constitutional symptoms of poor oral intake and abdominal pain. She experienced normal body temperature (36.7C), pulse rate (78/min), and respiratory rate (18/min) but high blood pressure (152/83 mmHg). A routine laboratory test performed 18 days after vaccination with the mRNA1273 (Moderna) vaccine exposed a serum creatinine (Cr) level of 1.25 mg/dL, and microscopic findings of urinalysis showed microscopic hematuria, occult blood (2+), 10C29 red blood cells (RBCs) per high-power field, and proteinuria (2+). The last previous laboratory test was performed in 2018 and was notable for any serum Cr level of 0.81 mg/dL. Within the 25th day time after vaccination, her Cr level elevated to 2.16 mg/dL. The spot urine protein to Cr percentage was 0.85 mg/gCr, and the spot urine albumin to Cr ratio was 0.19 mg/gCr. Despite intravenous hydration, the creatine level remained elevated, and with this getting along with prolonged hematuria with proteinuria, we were prompted to perform serological screening. Serological tests exposed positive ANCA titers (> 120 IU/mL) and antibodies against MPO. Anti-nuclear antibody (ANA), anti-phospholipase A2 receptor (PLA2R) antibody, and anti-glomerular basement membrane antibody were all negative. The rheumatoid element titer was 221 IU/mL and the C3 and C4 levels were 121 and 18 mg/dL, while immunoglobulins levels were all within normal limits (immunoglobulin [Ig] A 197 mg/dL, IgG 1,121 mg/dL, and IgM 96 mg/dL). Kidney imaging showed a remaining kidney cyst; normally, no abnormal findings were present. A kidney biopsy (Fig. 1) showed fibrocellular crescents (42.9%) and global sclerosis (14.3%) in glomeruli, with focal moderate tubular atrophy found 30 days after vaccination with the mRNA1273 (Moderna) vaccine. Immune complex-mediated deposits were not seen by electron microscopy. ANCA-associated pauci-immune crescentic glomerulonephritis was diagnosed based on the serological test and kidney biopsy findings. After kidney biopsy, intravenous pulse steroid therapy was initiated; 500 mg of methylprednisolone sodium succinate was injected intravenously over 1 hour once daily for three days. Two weeks after admission, her serum Cr level was elevated from 1.25 mg/dL (glomerular filtration rate [GFR], 42.1 mL/min/1.73 m2) to 4.71 mg/dL (GFR, 9.1 mL/min/1.73 m2) (Table 1). The plasmapheresis is considered when a individuals serum Cr level is definitely above 5.7 mg/dL as the guideline,5 however, it was initiated considering the individuals rapid deterioration of renal function and biopsy findings showing crescents in nearly 50% of glomeruli. Intravenous cyclophosphamide 2.5 mg/kg was administered because of severe glomerulonephritis, and a reduced dose was given based on the patients age (> 70 years) and GFR less.