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Asfeen U, Raj R, Ezeafulukwe CJ, Hassan OA, Francis DT, Dhillon SS, Khan A. Amiodarone-Induced Leukocytoclastic Vasculitis in a Decompensated Heart Failure Patient: A Case Report. Cureus 2024; 16:e51817. [PMID: 38327906 PMCID: PMC10847063 DOI: 10.7759/cureus.51817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/09/2024] Open
Abstract
Leukocytoclastic vasculitis (LCV) is a small-vessel vasculitis characterized by inflammation and damage to the walls of small blood vessels. It typically presents with palpable purpura and can be associated with various systemic conditions. Although its etiology is diverse, LCV has been associated with systemic diseases, infections, medications, and autoimmune disorders. Here, we present a case of LCV in a patient with decompensated heart failure. A 58-year-old man presented with progressively deteriorating swelling in both his lower limbs and scrotum, a persistent dry cough associated with minor ulcerative lesions on his shins, and a patchy rash with pustules and flat reddish spots. He was hospitalized three days prior due to atrial fibrillation and rapid ventricular rate, for which he was commenced on amiodarone. This rash persisted for three days, yet he denied experiencing any discomfort or itchiness along with it. Based on his clinical picture, laboratory evaluations, and imaging findings, he was diagnosed with LCV induced by amiodarone.
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Affiliation(s)
- Ummul Asfeen
- Internal Medicine, New York Medical College, Saint Michael's Medical Center, Newark, USA
| | - Rohan Raj
- Internal Medicine, Nalanda Medical College and Hospital, Patna, IND
| | | | - Omar A Hassan
- General Practice, Ondokuz Mayis University, Samsun, TUR
| | | | - Sukhmeet S Dhillon
- Internal Medicine, Baba Farid University of Health Sciences, Patiala, IND
| | - Aadil Khan
- Trauma Surgery, OSF Saint Francis Medical Center, University of Illinois Chicago, Peoria, USA
- Cardiology, University of Illinois Chicago, Illinois, USA
- Internal Medicine, Lala Lajpat Rai Hospital, Kanpur, IND
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Wang Y, Yang L, Xu G. New-Onset Acute Interstitial Nephritis Post-SARS-CoV-2 Infection and COVID-19 Vaccination: A Panoramic Review. J Epidemiol Glob Health 2023; 13:615-636. [PMID: 37870719 PMCID: PMC10686899 DOI: 10.1007/s44197-023-00159-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023] Open
Abstract
The 2019 coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) has posed a considerable challenge to global healthcare. Acute interstitial nephritis (AIN) post SARS-CoV-2 infection and vaccination has been reported, but its clinical features and pathogenesis remained unclear. We reviewed so far the largest 22 cases of AIN post SARS-CoV-2 infection and 36 cases of AIN following COVID-19 vaccination. The onset of AIN was mainly related to messenger RNA vaccines (52.8%). Apart from fever, proteinuria (45.5%) was the main manifestation of AIN post SARS-CoV-2 infection, left acute kidney injury (AKI, 63.9%) in patients post COVID-19 vaccination. The potential mechanism of vaccination induced AIN was conjugating vaccines with proteins to form a hapten, which activated dendritic cells and promoted a cascade immunological reaction leading to AIN.
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Affiliation(s)
- Yu Wang
- Department of Nephrology, Donghu District, the Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, Jiangxi, China
| | - Ling Yang
- Department of Health Management Medicine, The Second Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Gaosi Xu
- Department of Nephrology, Donghu District, the Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, Jiangxi, China.
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Missoum S, Lahmar M, Khellaf G. [Leukocytoclastic vasculitis and acute renal failure following inactivated SARS-CoV-2 vaccine]. Nephrol Ther 2021; 18:287-290. [PMID: 35074300 PMCID: PMC8651508 DOI: 10.1016/j.nephro.2021.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/27/2021] [Accepted: 10/30/2021] [Indexed: 12/19/2022]
Abstract
Les vaccins contre le SRAS-CoV-2 sont administrés dans le monde entier. La plupart des effets secondaires sont légers et spontanément résolutifs, avec peu de cas signalés de réactions graves. Nous rapportons un cas de vascularite leucocytoclasique avec insuffisance rénale aiguë à la suite d’un vaccin à SARS-CoV-2 inactivé, unique pour sa présentation visuelle spectaculaire et sa réponse rapide au traitement. Il s’agit d’un homme âgé de 58 ans présentant de la fièvre, des arthralgies et un purpura vasculaire au niveau des quatre membres, le tout associé à une insuffisance rénale aiguë nécessitant une hémodialyse neuf jours après la vaccination anti-COVID-19. La biopsie cutanée a révélé une vascularite leucocytoclasique et la biopsie rénale une néphrite tubulo-interstitielle aiguë. Le purpura vasculaire s’est résolu 7 jours après le début du traitement par prednisone, mais le patient a conservé une insuffisance rénale chronique modérée. L’analyse et les enquêtes sur les complications et les événements indésirables induits par les vaccins anti-COVID-19 pourraient améliorer notre compréhension de la pathogenèse sous-jacente.
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Affiliation(s)
- Soumia Missoum
- Département de médecine, université de Batna, route de Constantine Fesdis, Batna, Algérie; Service de néphrologie, CHU Benflis Touhami, route de Tazoult, Batna, Algérie.
| | - Mourad Lahmar
- Département de médecine, université de Batna, route de Constantine Fesdis, Batna, Algérie; Service d'anesthésie réanimation, CAC, route de Tazoult, Batna, Algérie
| | - Ghalia Khellaf
- Département de médecine, université d'Alger, 02, rue Ahmed Ouaked Dely Ibrahim, Alger, Algérie; Service de néphrologie, CHU Lamine Debaghinel, Saint-Eugene Beb El Oued, Alger, Algérie
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Awad MH, El-Hawary A, Sawah G, Nasef N. Pan-vasculitis and fulminant hepatitis following routine vaccination at the age of 4 months. Clin Exp Vaccine Res 2021; 10:78-80. [PMID: 33628757 PMCID: PMC7892943 DOI: 10.7774/cevr.2021.10.1.78] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/24/2021] [Accepted: 01/25/2021] [Indexed: 11/17/2022] Open
Abstract
Vaccines are known to have side effects, most of which are tolerable. Vasculitis following vaccination is reported and has various modes of presentation. We report a 4-month-old girl presented with an unusual presentation of fulminant hepatitis, pan vasculitis, and diffuse body aneurysms following routine immunization diagnosed by echocardiography and computed tomography angiogram. It is important to be aware of different possible adverse effects following vaccines and their different modes of presentation as well as possible treatments such as intravenous immunoglobulins and high dose methylprednisolone.
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Affiliation(s)
- Mohammad Hosny Awad
- Department of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - Amany El-Hawary
- Department of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - Gehan Sawah
- Department of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - Nehad Nasef
- Department of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
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Chen SX, Cohen PR. Cutaneous Leukocytoclastic Vasculitis Following Influenza Vaccination in Older Adults: Report of Bullous Purpura in an Octogenarian after Influenza Vaccine Administration. Cureus 2018; 10:e2323. [PMID: 29765791 PMCID: PMC5951600 DOI: 10.7759/cureus.2323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/14/2018] [Indexed: 11/05/2022] Open
Abstract
The influenza vaccination is recommended annually for protection against influenza infection. Adults over 65 years of age are especially vulnerable to complications from influenza infection; in addition, they constitute the largest group of influenza vaccination recipients each year. Cutaneous leukocytoclastic vasculitis involves inflammation of small vessel walls by neutrophils. An 88-year-old man with a history of idiopathic pulmonary fibrosis who developed bullous cutaneous leukocytoclastic vasculitis 14 days after receiving the influenza vaccine is described and the characteristics of influenza-associated cutaneous leukocytoclastic vasculitis in older individuals are reviewed.
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Affiliation(s)
- Stella X Chen
- School of Medicine, University of California, San Diego
| | - Philip R Cohen
- Department of Dermatology, University of California, San Diego
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Vera-Lastra O, Medina G, Cruz-Dominguez MDP, Jara LJ, Shoenfeld Y. Autoimmune/inflammatory syndrome induced by adjuvants (Shoenfeld's syndrome): clinical and immunological spectrum. Expert Rev Clin Immunol 2013; 9:361-73. [PMID: 23557271 DOI: 10.1586/eci.13.2] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
An adjuvant is a substance that enhances the antigen-specific immune response, induces the release of inflammatory cytokines, and interacts with Toll-like receptors and the NALP3 inflammasome. The immunological consequence of these actions is to stimulate the innate and adaptive immune response. The activation of the immune system by adjuvants, a desirable effect, could trigger manifestations of autoimmunity or autoimmune disease. Recently, a new syndrome was introduced, autoimmune/inflammatory syndrome induced by adjuvants (ASIA), that includes postvaccination phenomena, macrophagic myofasciitis, Gulf War syndrome and siliconosis. This syndrome is characterized by nonspecific and specific manifestations of autoimmune disease. The main substances associated with ASIA are squalene (Gulf War syndrome), aluminum hydroxide (postvaccination phenomena, macrophagic myofasciitis) and silicone with siliconosis. Mineral oil, guaiacol and iodine gadital are also associated with ASIA. The following review describes the wide clinical spectrum and pathogenesis of ASIA including defined autoimmune diseases and nonspecific autoimmune manifestations, as well as the outlook of future research in this field.
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Affiliation(s)
- Olga Vera-Lastra
- Hospital de Especialidades Centro Médico La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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Renal Failure After Swine Flu Vaccination: An Observation. Int J Organ Transplant Med 2010. [DOI: 10.1016/s1561-5413(10)60020-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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