Sex: F
Vaccine: COVID19
Symptoms: Antibody test, Antineutrophil cytoplasmic antibody, Antinuclear antibody, Biopsy kidney, Blood albumin
Clinical narrative: In the kidney,the T-cell response provokes swift production of cytokines, which could trigger podocytopathies and glomerulonephritis (GN)/fourth case of tip lesion FSGS reported post-COVID vaccination; This is a literature report.  The global coronavirus 2019 (COVID-19) pandemic has caused extensive morbidity and mortality worldwide during the past year. Covid vaccines have demonstrated excellent safety profiles, with myocarditis and pericarditis as their most severe side effects. In the kidney, the T-cell response provokes swift production of cytokines, which could trigger podocytopathies and glomerulonephritis (GN). As more vaccines are being administered, the authors are encountering rarer side effects. A 31-year-old female complained of worsening leg edema two weeks after her 2nd dose of Pfizer Covid vaccine. Her exam was normal except for bilateral pitting leg edema. UA showed proteinuria >1000 with blood 27.3/hpf. Labs showed hemoglobin, 10 g/dL; creatinine, 1.2 mg/dL; total protein, 4.6 g/dL; albumin, 2.4 g/dL; total cholesterol, 290 mg/dL; spot UPCR, 4.3 g/g; serum k/(lambda) ratio, 1.13; C3 and C4 at 112 and, 26 mg/dL. She also had negative serologies for HIV, RPR, Hepatitis B and C, anti dsDNA, anti-smith, cryoglobulin, PLA2R, ANA, ANCA, and SPEP. A kidney biopsy showed on a Light microscope glomeruli tuft consolidation with focal foam cells and foci of confluence with the origin of proximal tubules. Immunofluorescence revealed glomeruli had segmental coarse granular capillary tuft reactivity with antisera specific for IgM, C3, C1q, Kappa light chain, lambda light chain most consistent with trapping in segmental sclerosis, and electron microscopy showed rare tuft lumen inflammatory cells, segmental basement membrane thinning, rare segmental matrix tinctorial variation and broad visceral epithelial foot processes effacement and segmental microvillous transformation present. Despite steroids at 1mg/kg daily with diuretics and ARBs for 16 weeks, the patient continued to have proteinuria and started on Rituximab. The most common FSGS reported occurring post-COVID vaccination is collapsing type. A literature search found very few cases (three) of tip variety post-COVID vaccine. To the best of the authors' knowledge, this is probably the fourth case of tip lesion FSGS reported post-COVID vaccination. As the authors are aware, out of all tip variety responds the best to steroids, the authors' case interestingly was found to be resistant to steroids which makes us think whether the vaccine has any role to play in its resistance.; Sender's Comments: Based on the available information in the case, an association between the reported events Focal segmental glomerulosclerosis and The suspected drug cannot be ruled out.  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.