Kidney Week

Abstract: SA-PO858

Refractory Nephrotic Syndrome Resulting in Bilateral Achilles Tendon Rupture Due to Relapse by Vaccination after Recovery from COVID-19: A Case Report

Session Information

• Glomerular Diseases: Case Reports - 2
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Takeoka, Jun, Kansai Denryoku Byoin, Osaka, Osaka, Japan

Jun Takeoka, MD

• Sato, Ryo, Kansai Denryoku Byoin, Osaka, Osaka, Japan

Ryo Sato

• Otsuka, Kansei, Kansai Denryoku Byoin, Osaka, Osaka, Japan

Kansei Otsuka

• Toda, Naohiro, Kansai Denryoku Byoin, Osaka, Osaka, Japan

Naohiro Toda, MD, PhD

• Fujita, Kyoka, Kansai Denryoku Byoin, Osaka, Osaka, Japan

Kyoka Fujita

• Kurahashi, Satoshi, Kansai Denryoku Byoin, Osaka, Osaka, Japan

Satoshi Kurahashi, MD

• Mochizuki, Kosuke, Kansai Denryoku Byoin, Osaka, Osaka, Japan

Kosuke Mochizuki, MD

• Hirashima, Hisako, Kansai Denryoku Byoin, Osaka, Osaka, Japan

Hisako Hirashima, APN

• Komiya, Toshiyuki, Otsu Sekijuji Byoin Toshoshitsu, Otsu, Shiga, Japan

Toshiyuki Komiya, MD, PhD

• Muso, Eri, Kansai Denryoku Byoin, Osaka, Osaka, Japan

Eri Muso, MD, PhD

• Ishii, Akira, Kansai Denryoku Byoin, Osaka, Osaka, Japan

Akira Ishii, MD, PhD, DrPH

Introduction

There are several reports suggesting the involvement of SARS-CoV-2 (COVID-19) infection and COVID-19 messenger RNA (mRNA)-based vaccine respectively in the development and severity of nephrotic syndrome. We report a case of refractory nephrotic syndrome resulting in bilateral Achilles tendon rupture due to relapse by vaccination shortly after recovery from COVID-19.

Case Description

A 60-year-old man was diagnosed with minimal change nephrotic syndrome (MCNS) 37 years ago and was in remission with steroid therapy. Although it recurred a total of five times over the next 36 years, the disease remained relatively stable, Two months before admission, he developed a COVID-19 pneumonia and was cured by treatment. Just two months later, he received the third dose of COVID-19 vaccine and was admitted to our department with generalized edema, rapid weight gain of 12 kg in 2 weeks, proteinuria (3.3 g/gCr) and hypoalbuminemia (2.9 mg/dL). After admission, steroid pulse therapy was started, and renal biopsy revealed MCNS recurrence. The patient was treated with steroid pulse therapy for three times and LDL apheresis, but the response was poor. Eight months after relapse, rituximab therapy was started. Although proteinuria gradually decreased, gait disturbance appeared and bilateral Achilles tendon ruptures were discovered.

Discussion

Although there have been scattered reports suggesting that COVID-19 infection and COVID-19 vaccine respectively have been implicated in the development and severity of nephrotic syndromes, including MCNS, the precise mechanism is not fully understood. In this case, vaccination shortly after COVID-19 recovery may have acted as a booster, causing the immune system to become abnormally activated and trigger a recurrence with severe edema leading to Achilles tendon rupture.