Sex: F
Vaccine: COVID19
Symptoms: Biopsy kidney, Blood creatinine, Disease recurrence, Glomerulonephritis minimal lesion, Protein urine
Clinical narrative: Reactivation of minimal change disease after vaccine; Reactivation of minimal change disease after vaccine; This is a literature report for the following literature source(s).  This case follows a 54-year-old woman with a medical history of hypertension who had reactivation of MCD after receiving the Pfizer vaccine. The patient provided informed verbal consent for her case to be presented. She was initially diagnosed with MCD in June2018, approximately 15 days after receiving the influenza vaccine. The initial presenting symptoms included foaming of the urine and severe edema of the legs. The diagnosis was made following a kidney biopsy. After a course of prednisone therapy, she remained in remission for 4 months. However, she relapsed in October2018 and was deemed to be in remission after being treated with prednisone the second time. She was tapered off the prednisone over the next 3 months, after a 6 months taper was originally planned. However, the patient experienced moon facies and blistering skin as adverse effects of taking steroids, so she requested a shorter taper period. She was diagnosed with chronic kidney disease (CKD stage 2) after the first episode of MCD. She did not receive the influenza vaccine or any other vaccine during the time she was in remission because she was concerned about a relapse. She chose to receive the Pfizer vaccine against COVID-19 because she works in healthcare. The presenting symptoms after reactivation included lower-extremity edema and foaming of urine. She experienced foaming of urine 1 week after the first dose of the Pfizer vaccine in January2021. She continued to have foaming of urine, but she chose to receive the second dose of the Pfizer vaccine 3 weeks following the first dose. She did not consult her doctors after she experienced symptoms following the first dose and chose to receive the second dose because she wished to be fully vaccinated. Within a week after receiving the second dose, she experienced worsening edema in her legs. Edemas a result, she was unable to walk, which prompted her to call her nephrologist, who ordered labs immediately. Eleven weeks had elapsed since she received her second dose of the vaccine and prior to her presenting to her nephrologist. Her serum creatinine upon presentation was 0.55mg/dL, and her urine protein was 9,977 mg/day. The diagnosis of relapse was made based on her labs and presenting symptoms. She was treated with prednisone 50mg/day, with improvement in her urine protein to 85 mg/g within 4 weeks. The dose of prednisone remained 50 mg/day during the 4 week period with a plan to taper the dose afterwards. She was encouraged to start treatment with rituximab, but the patient declined when she had to travel to her home country to care for her elderly mother. She is currently on a prolonged prednisone taper with plans to start treatment with rituximab if she relapses. Symptomatic treatment can also be provided with the use of OMT techniques such as a pedal pump, a thoracic pump, a thoracic inlet release, and an extremity pump. This case describes a 54-year-old woman that presented with reactivation of MCD in the setting of a recent COVID-19 vaccine administration. The possibility that the relapse could be secondary to stopping the steroid taper earlier than planned after the first episode of MCD cannot be ruled out. However, the fact that the initial episode of MCD occurred following the influenza vaccine and the fact that she was in remission for more than 3 years prior to having her COVID-19 vaccination points to the vaccine as the major factor for the relapse. The pathophysiology of MCD secondary to having her COVID-19 vaccines is hypothesized to be related to molecular mimicry. The t cells produced after vaccine administration attack the podocytes, leading to injury. Development of MCD has also been reported after influenza, hepatitis B, pneumococcal, measles, and tetanus-diphtheria-poliomyelitis vaccines. So far, there have been eight reported cases of reactivation of MCD worldwide following vaccination against COVID-19 with the Pfizer, AstraZeneca, and Moderna vaccines. The vaccines from Pfizer and Moderna are both mRNA-based vaccines, whereas AstraZeneca's vaccine is a DNA-based vaccine. Among the above cases, five were reported following the Pfizer vaccine, two occurred after the AstraZeneca vaccine, and one followed the Moderna vaccine. Although further studies of the relationship between MCD and the COVID-19 vaccine are warranted, awareness of this phenomenon may be beneficial in early diagnosis and treatment. At this time, more cases of reactivation of MCD have been reported following the Pfizer vaccine when compared to the Moderna vaccine, even though they are both mRNA vaccines. Further data are required to determine whether one vaccine is more likely to lead to reactivation of MCD than others. In addition, it is important to monitor the disease course of patients who experience reactivation of MCD after receiving a COVID-19 vaccine in order to weigh the risks vs benefits of any type of COVID-19 vaccine in patients with a history of MCD, especially in the setting of the pandemic and evolving data. Patients with a history of activation or relapse of MCD after prior vaccines should be cautious when considering receiving the COVID-19 vaccine. If patients choose to receive the COVID-19 vaccine after weighing the risks and benefits, they should be informed to stay vigilant about the presenting symptoms of MCD and be encouraged to receive treatment as soon as possible. Treatment could include a combination of glucocorticoids and symptomatic treatment with OMT.; Sender's Comments: Based on the known the information available the Causal relation between the events Minimal change disease, Disease recurrence and suspect drug cannot be excluded completely The impact of this report on the benefit/risk profile of the Pfizer drug is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees, and Investigators, as appropriate.,Linked Report(s) : US-PFIZER INC-202300266404 Same article/patient/event and different drug;