Sex: F
Vaccine: COVID19
Symptoms: Lupus nephritis, Lymphocyte count, Neutrophil count, Physical examination, Platelet count
Clinical narrative: systemic lupus erythematosus; class V lupus nephritis; This is a literature report.  A 36-year-old woman developed lupus nephritis and systemic lupus erythematosus (SLE) following COVID-19 vaccination with tozinameran [route, dosage and duration of treatment to reaction onset not stated]. The woman received her first dose of tozinameran [Pfizer vaccine]. However, following her first dose of tozinameran, she developed fever of 39Centigrade.On subsequent days, she developed rash on helices and concha, which extended to her face and arms. Further, her fever persisted, and she developed arthralgia, watery diarrhoea, dry cough, shortness of breath and fatigue. Her laboratory findings showed lymphopenia, and her WBC, absolute neutrophil count, absolute lymphocyte count, Hb and platelet count were decreased. Further, laboratory findings showed positive anti-nuclear antibody, anti-double stranded DNA, anti- ribonucleoprotein, herpes simplex virus type-2, immunoglobulin (Ig)-G and varicella IgM. Subsequently, she received valaciclovir for varicella zoster virus infection. Further, she developed oral ulcers, and she was admitted to the emergency department (ED) for further management. In ED her physical examination showed papular pink and violaceous rash, on cheeks and nose accompanied with crusted papules and plaques on noted on ears bilaterally. Additionally, she had oral and vaginal candidiasis, and her both hand, back and thigh demonstrated scaly erythematous papules. Her skin biopsy showed, leukocytoclastic vasculitis. Further, findings showed hypocomplementemia, positive Coomb's test, pancytopenia, protein urea, mucosal ulcer, alopecia and arthritis. Based on her clinical presentation and laboratory findings she was diagnosed with SLE. Subsequently, the woman was treated with hydroxychloroquine, prednisone and unspecified antifungals (for oral and vaginal candidiasis). Further, class V lupus nephritis was confirmed from her kidney biopsy. Therefore, she was initiated with mycophenolate-mofetil. Subsequently, she became afebrile, and there was improvement in her rash, mucosal ulcer, arthralgias, WBC, platelet count and proteinuria and she was discharged. Later, she tapered off her prednisone.Later, her mycophenolate-mofetil was switched to azathioprine as she wanted to get pregnant. Later, she developed a flare of SLE and class V lupus nephritis. Therefore, her azathioprine dose was increased, and tacrolimus and low-dose prednisone were added. Subsequently, her condition improved, and proteinuria also reduced. The Author Comment: The Pfizer COVID-19 vaccine [tozinameran] may lead to de novo systemic lupus erythematosus. There are few cases highlighting new-onset disease after [tozinameran] vaccination and even less with lupus nephritis. The outcome of the events was recovering.; Sender's Comments: The female patient developed lupus nephritis and systemic lupus erythematosus following COVID-19 vaccination with tozinameran.  More epidemiologic data and cumulative safety reports collected post marketing use are needed to indicate if there is the potential causal link between the vaccination and the events occurrence.  Immunological and virologic workups would be investigated to identify any alternative etiologies. The impact of this report on the benefit/risk profile of the Pfizer product 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