A 63-year-old male patient with a history of habitual tonsillitis underwent bilateral tonsillectomy. He had a history of alcoholic cirrhosis of the liver and microscopic hematuria and proteinuria were indicated during a health checkup 2 years before hospital admission. He developed hematuria after the SARS-CoV-2 vaccination, which led to rapidly progressive glomerulonephritis, for which he was hospitalized. A renal biopsy led to the diagnosis of IgA nephropathy. Although pulse steroid therapy during his condition resulted in hepatic encephalopathy, three courses combined with mizoribine improved his renal function.
SARS-CoV-2 mRNA vaccines activate T cells, which are involved in the pathophysiology of IgA nephropathy. Therefore, this case suggests that the exacerbation of IgA nephropathy by the vaccine favors the vasculitis aspect of the disease.
方法:一名有习惯性扁桃体炎病史的63岁男性患者接受了双侧扁桃体切除术。他有酒精性肝硬化病史,入院前2年的健康检查中发现镜下血尿和蛋白尿。他在SARS-CoV-2疫苗接种后出现血尿,导致快速进展性肾小球肾炎,为此他住院了。肾活检导致IgA肾病的诊断。尽管在他的病情期间进行脉冲类固醇治疗会导致肝性脑病,三个疗程联合咪唑立宾改善了他的肾功能。
结论:SARS-CoV-2mRNA疫苗激活T细胞,这与IgA肾病的病理生理学有关。因此,这种情况表明疫苗对IgA肾病的加重有利于该疾病的血管炎方面。