Dr Sadia Jahan1, Dr Arvinf Rajandran1, Dr Nur Fariszah Baharuddin1, A/Prof Nitesh Rao1, Dr Bee Qung Tan1
1Renal Unit, Lyell McEwin Hospital, Adelaide, Australia
Background
The coronavirus pandemic has changed lives forever. The effect of this virus on morbidity and mortality is evolving and devastating. Some diseases are triggered not only by the infection but also by the vaccine. There are well-established cases of glomerulonephritis, including minimal change disease and membranous nephropathy. We present a diagnosis of amyloid one week after the Pfizer-BioNTech COVID-19 vaccine.
Case Report
A 60-year-old male of Laos descent who has been in Australia since the 1980s presented with acute onset of peripheral oedema and weight gain one week after receiving the second dose of mRNA Pfizer-BioNTech COVID-19 vaccine. He had no past medical history and was not taking regular medications, including over the counter remedies.
The laboratory investigation revealed serum creatinine 69umol/L and serum albumin 16g/L. 24-hour urine yielded 5g of protein. Renal biopsy showed Congo red staining of amyloid deposits. The myeloma work-up showed a serum free light chain ratio of 0.78, IgG kappa 3g/L paraprotein and positive urine Bence jones protein. The bone marrow biopsy demonstrated 10% plasma cell aggregates via CD138 and amyloid deposit within extramedullary tissue. He received bortezomib, cyclophosphamide and dexamethasone chemotherapy without haematological response and is currently being worked up for a stem cell transplant.
Conclusions
There are implications of S-protein in COVID-19 disease and vaccine, which are still under research in the literature. Our case highlights the importance of the prompt investigation, including biopsy in patients with life changing symptoms post vaccination.
Biography:
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