Woman develops aHUS after COVID-19 vaccine dose: Case report
Nausea, vomiting, weakness started 15 days after vaccination
A woman developed atypical hemolytic uremic syndrome (aHUS) after receiving the first dose of a COVID-19 vaccine, according to a case study from Brazil.
The researchers said the “connection of symptoms post-COVID-19 vaccination to aHUS … emphasizes the need for ongoing monitoring and research into vaccine-related complications.”
The case was described in the study, “Atypical hemolytic-uremic syndrome after COVID-19 vaccine: A case report,” published in Immunity, Inflammation, and Disease.
Recent studies have indicated that COVID-19 vaccination may be associated with uncommon adverse events, including thrombotic microangiopathy (TMA). TMAs are disorders that are marked by the formation of blood clots in small blood vessels leading to organ damage, along with red blood cell destruction, and low platelet counts. There are three main types of TMAs, one of which is aHUS.
Here, researchers described the case of a 25-year-old woman who started experiencing general discomfort, nausea, vomiting, and physical weakness 15 days after receiving the first dose of the AstraZeneca COVID-19 vaccine. She subsequently developed swelling in both legs and shortness of breath during periods of exertion. She also had persistent abdominal pain and nausea.
Symptoms return, new ones emerge
The woman was treated for her symptoms in the emergency department and was discharged after 10 days, once her condition improved. However, 60 days after vaccination, she returned to the emergency department with the same symptoms, accompanied by high blood pressure.
Initial laboratory tests revealed she had kidney dysfunction, but there were no changes in blood cell counts. After five days of supportive care, her condition improved and she was discharged with instructions to take a blood pressure-lowering medication.
Three weeks later, she returned with acute hypertensive pulmonary edema — a condition characterized by the accumulation of fluid in the lungs — along with worsened kidney function, anemia, high levels of neutrophils (a type of immune cell), and low platelet counts.
Further laboratory tests were consistent with a TMA diagnosis, including the presence of schistocytes (red blood cell fragments) in the blood, high levels of lactate dehydrogenase (a marker of cell and tissue injury), and proteins and blood in the urine.
No mutations were found in genes encoding proteins of the complement system, and there was no evidence of viral infections, autoimmune conditions, or changes in complement protein levels.
A kidney biopsy revealed a pattern of tissue damage characteristic of TMA and indicative of an aHUS diagnosis.
Clinical improvement was achieved with early initiation of invasive breathing support, intravenous (into-the-vein) treatment with blood pressure-lowering medication, and kidney replacement therapy.
The woman was discharged after two weeks and continued receiving outpatient follow-up care and hemodialysis treatment for insufficient urine production.
Similar cases, most involving women, have been reported after a first vaccine dose and without previous alterations to kidney function. The researchers said their case differed from previous reports “by presenting itself in a patient of age below the average age of the cases reported, in addition to having been caused after the application of an adenoviral vector vaccine … starting symptoms after 15 days of the administration and not showing complete remission of the case and still requiring hemodialysis.”
“Despite the critical role of vaccination in pandemic control, emerging adverse events, such as vaccine-related TMA, must be recognized and investigated,” they wrote. “Additional clinical trials are imperative to comprehend the clinical features and pathophysiological [disease] mechanisms underlying TMA associated with COVID-19 vaccination.”
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