Influenza vaccination-associated cryoglobulinemic vasculitis.

Area of Science:

• Nephrology
• Immunology
• Vaccinology

Background:

• Mixed cryoglobulinemia is a small vessel vasculitis often linked to viral infections like hepatitis C, autoimmune diseases, or lymphoproliferative disorders.
• While rare, associations between vaccinations and cryoglobulinemia have been occasionally reported, necessitating further investigation.

Observation:

• A 68-year-old male experienced recurrent episodes of purpuric rash and lower extremity swelling after influenza vaccination.
• Subsequent presentations included thrombocytopenia and nephritic syndrome, with lab work confirming mixed cryoglobulins.

Findings:

• Kidney biopsy revealed endocapillary proliferative glomerulonephritis with organized deposits, characteristic of mixed cryoglobulinemic glomerulonephritis.
• Treatment with rituximab resulted in significant improvement of acute kidney injury and complete patient recovery.

Implications:

• This case underscores the importance of considering influenza vaccine as a potential trigger for mixed cryoglobulinemia, even if rare.
• Prompt diagnosis and treatment, such as with rituximab, are crucial for managing cryoglobulinemic glomerulonephritis and preventing severe kidney damage.
• Further research is warranted to elucidate the mechanisms underlying vaccine-induced cryoglobulin production.