SHM Converge Scientific Abstract ePoster Gallery-Scleroderma Renal Crisis Following Mrna Covid-19 Vaccination

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This case report describes a 50-year-old woman with mixed connective tissue disease, interstitial lung disease, chronic kidney disease, and prior stroke who developed a scleroderma renal crisis shortly after receiving her first mRNA COVID-19 vaccine. Two days after vaccination, she experienced nausea, vomiting, diarrhea, anorexia, worsening dyspnea, and neurologic symptoms. She rapidly deteriorated into agonal breathing, bradycardia, and pulseless electrical activity, requiring resuscitation, intubation, and ICU care.<br /><br />On admission, she had a hypertensive emergency (230/127 mmHg), acute kidney injury (creatinine 2.7 mg/dL from a baseline of 1.65), severe metabolic acidosis, elevated lactate, leukocytosis, anemia, and markedly elevated BNP and troponin. Cardiac evaluation showed severe concentric left ventricular hypertrophy, reduced ejection fraction, diastolic dysfunction, and pulmonary hypertension. Imaging showed bilateral pulmonary infiltrates and cardiomegaly, while infectious workup was negative.<br /><br />She was treated with fluids, bicarbonate, antibiotics, vasopressors briefly, and aggressive blood pressure control using nicardipine, enalapril, later captopril, labetalol, and nifedipine. Mycophenolate was resumed. Her renal function improved without dialysis, and she was extubated on hospital day 6.<br /><br />The authors suggest that immune and inflammatory responses triggered by mRNA vaccination may have contributed to endothelial injury and precipitated scleroderma renal crisis in this susceptible patient. They note that COVID-19 vaccines have been associated with rare renal complications, including glomerular disease and acute kidney injury, and recommend further studies and early kidney biopsy in similar cases.

Asset Subtitle

Cristine K. Arcilla

Meta Tag

Author List Amy Pulikeyil, Cristine K. Arcilla, Natalia Plotskaya

Category Clinical Vignettes

Concept Scleroderma Renal Crisis

Concept Hypertensive Emergency

Concept Acute Kidney Injury

Concept Blood Pressure Control

Concept ACE Inhibitor

Distinguished Non-Finalist

Presenter Organization Capital Health Regional Medical Center

Presenting Author Cristine K. Arcilla

Track Adult

Keywords

mixed connective tissue disease

scleroderma renal crisis

mRNA COVID-19 vaccine

acute kidney injury

hypertensive emergency

interstitial lung disease

pulmonary hypertension

metabolic acidosis

cardiac dysfunction

endothelial injury

Scleroderma Renal Crisis

Hypertensive Emergency

Acute Kidney Injury

Blood Pressure Control

ACE Inhibitor