Age: 24.0
Sex: M
Vaccine: COVID19
Symptoms: Double stranded DNA antibody, Glomerulonephritis, Intrinsic factor antibody, Microscopy, Protein urine
Clinical narrative: Seronegative full-house immune complex glomerulonephritis; This literature-non-study case was reported in a literature article and describes the occurrence of GLOMERULONEPHRITIS (Seronegative full-house immune complex glomerulonephritis) in a 24-year-old male patient who received mRNA-1273 (Spikevax) for COVID-19 prophylaxis.        The patient's past medical history included Portal vein thrombosis (Patient had Idiopathic portal vein thrombosis in childhood.), Portal hypertension (Patient had portal hypertension post splenorenal shunt.), Splenorenal shunt procedure and Splenectomy (5 years prior).   On an unknown date, the patient received second dose of mRNA-1273 (Spikevax) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Spikevax) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced GLOMERULONEPHRITIS (Seronegative full-house immune complex glomerulonephritis) (seriousness criterion medically significant). The patient was treated with CYCLOPHOSPHAMIDE at a dose of 750 milligram. At the time of the report, GLOMERULONEPHRITIS (Seronegative full-house immune complex glomerulonephritis) was resolving.      DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Antinuclear antibody: (Negative) Negative. On an unknown date, Biopsy kidney: showed membranoproliferative pattern of injury on light microscopy with one fibrocellular crescent and without IFTA (interstitial fibrosis and tubular atrophy). On an unknown date, Blood albumin: 0.9 g/dL. On an unknown date, Blood creatinine: One month after treatment, improved to 0.92 and 3.04 mg/dl baseline 0.7. On an unknown date, Complement factor: Low and Normal. On an unknown date, Double stranded DNA antibody: (Negative) Negative. On an unknown date, Intrinsic factor antibody: revealed full house staining. On an unknown date, Microscopy: showed severe subepithelial deposits with subendothelial and mesangial deposits. No tubuloreticular inclusions were present. On an unknown date, Protein urine: 6.05 gram per gram After treatment. On an unknown date, Serology test: (Negative) Negative. On an unknown date, Urine protein/creatinine ratio: 50.52 gram per gram.     For mRNA-1273 (Spikevax) (Unknown), the reporter considered GLOMERULONEPHRITIS (Seronegative full-house immune complex glomerulonephritis) to be related.    No concomitant medications were reported.  Patient presented with 9 weeks of progressive edema, ascites, and foamy urine. Patient's symptoms started then worsened after his 1st and 2nd doses of the mRNA-1273 COVID-19 vaccination (Moderna).  The patient received high dose steroids. Patient had a rapid and robust response to immunosuppression.  Laboratory tests also included infectious work up which was reported as negative.  Authors noted that the high potency of mRNA COVID-19 vaccine can induce a robust immune response which may incite or unmask GNs2. Patient had a rapid and robust response to immunosuppression.  Authors concluded that seronegative full-house immune complex GN may occur after receiving mRNA SARS-CoV-2 vaccination and nephrologists should be aware of potential association.  Company Comment  This is a literature-non-study case concerning a 24-year-old male patient, with no relevant medical history, who experienced the serious (due to medically significant) and unexpected event of glomerulonephritis (reported as Seronegative full-house immune complex glomerulonephritis). As per source document, he presented with 9 weeks of progressive edema, ascites, and foamy urine. His symptoms started then worsened after his 1st and 2nd doses of the mRNA-1273 vaccine. Blood creatine peaked at 3.04mg/dl (baseline 0.7) and Urine protein/creatinine ratio at 50.52 g/g. Serum albumin was at 0.9 g/dl and complements were low. ANA and anti-DS DNA were negative as were other serologies and infectious work up. A kidney biopsy showed membranoproliferative pattern of injury on light microscopy with one fibrocellular crescent and without interstitial fibrosis and tubular atrophy. The microscopy revealed severe subepithelial deposits with subendothelial and mesangial deposits. No tubuloreticular inclusions were present. He received cyclophosphamide and high dose steroids. A month after treatment, blood creatine improved to 0.92 and proteinuria fell to 6.05g/g. Complements returned to normal. It was reported that the high potency of mRNA COVID-19 vaccine can induce a robust immune response which may incite or unmask glomerulonephritis. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.  Most recent FOLLOW-UP information incorporated above includes: On 01-Sep-2022: Live follow-up received by safety on 01-Sep-2022 has email with full text article received and contains significant information. Reporter information was updated.; Sender's Comments: This is a literature-non-study case concerning a 24-year-old male patient, with no relevant medical history, who experienced the serious (due to medically significant) and unexpected event of glomerulonephritis (reported as Seronegative full-house immune complex glomerulonephritis). As per source document, he presented with 9 weeks of progressive edema, ascites, and foamy urine. His symptoms started then worsened after his 1st and 2nd doses of the mRNA-1273 vaccine. Blood creatine peaked at 3.04mg/dl (baseline 0.7) and Urine protein/creatinine ratio at 50.52 g/g. Serum albumin was at 0.9 g/dl and complements were low. ANA and anti-DS DNA were negative as were other serologies and infectious work up. A kidney biopsy showed membranoproliferative pattern of injury on light microscopy with one fibrocellular crescent and without interstitial fibrosis and tubular atrophy. The microscopy revealed severe subepithelial deposits with subendothelial and mesangial deposits. No tubuloreticular inclusions were present. He received cyclophosphamide and high dose steroids. A month after treatment, blood creatine improved to 0.92 and proteinuria fell to 6.05g/g. Complements returned to normal. It was reported that the high potency of mRNA COVID-19 vaccine can induce a robust immune response which may incite or unmask glomerulonephritis. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.