New-onset severe eosinophilic granulomatosis with polyangiitis following the third dose of mRNA COVID-19 vaccine: A case report.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a complex multifactorial disease that results in multisystemic inflammation of the small- and medium-sized arteries. The exact pathogenesis of this syndrome is poorly understood, but it is postulated to result from a combination of eosinophilic dysfunction, genetic predisposition, and the development of autoantibodies after exposure to an unknown stimulus. We describe a case of new-onset EGPA following the third dose of the Pfizer-BioNTech mRNA vaccine in an infection-naive middle-aged man with a background history of allergic respiratory symptoms. The patient developed acute onset of mononeuritis multiplex, pauci-immune glomerulonephritis, and leucocytoclastic vasculitis 10 days after receiving the booster dose. His laboratory markers including eosinophil count, antineutrophil cytoplasmic antibodies, and renal function tests improved markedly after the initiation of pulse steroid therapy and rituximab infusion. However, his peripheral muscle weakness and neuropathic pain did not respond to the initial therapy but improved later with intravenous cyclophosphamide and intravenous immunoglobulin. To the best of our knowledge, this is the fourth case report of post-coronavirus disease 2019 vaccination precipitation of EGPA. All reported cases including our report were in patients with previous allergic manifestations who received mRNA-based coronavirus disease 2019 vaccines, and all the patients developed mononeuritis multiplex at presentation. Despite the few reported cases of post-vaccination autoimmune phenomena, the temporal association between vaccination administration and disease onset does not indicate causality, given the mass vaccination programmes employed. However, the novel use of the mRNA platform in vaccine delivery necessitates vigilant monitoring by the scientific committee.

[Valvular calcifications in a patient on hemodialysis in Morocco]. / Calcifications valvulaires chez l'hémodialysé au Maroc.

INTRODUCTION: Valvular calcifications are one of the major cardiovascular complications of hemodialysis because of its prevalence and its predictive indices of morbidity and mortality. There are many risk factors associated with these calcifications. Our study aims to evaluate both the prevalence of valvular calcifications in our patients on hemodialysis and their risk factors. METHODS: This was a single-center cross-sectional descriptive and analytical study of 111 adult patients who were on hemodialysis for more than 6 months at the hemodialysis center CHU Ibn Rushd, Casablanca and who underwent ETT during the year 2013. RESULTS: The average age of our patients was 44 ± 14 years. The average duration of hemodialysis was 146 ± 80 months. Average systolic blood pressure was 123 ± 23 mmHg and average diastolic blood pressure 72 ± 13 mmHg diastolic, average iPTH was 529 ± 460 pg/ml, mean serum calcium was 86 ± 10 mg/l and mean serum phosphate was 40 ± 15 mg/l. Mean CRP level was 11±19,8 mg/L. From the therapeutic point of view, 96% of patients were treated with calcium carbonate, 11% with 25 OH vitamin D, 55,5% with 1 hydroxy-vitamin D3. The prevalence of valvular calcification was 15% with aortic valve location in 41.2% and mitral valve location in 41.2%. In univariate analysis, only hemodialysis duration seems to be associated with the occurrence of calcifications and approaches marginal level of significance (p = 0.09). CONCLUSION: The prevalence of valvular calcification in our hemodialysis patients remains high even if it seems relatively low compared to the literature data. No known risk factor was significantly associated with these calcifications.

Pulmonary hypertension: prevalence and risk factors.

INTRODUCTION: Pulmonary arterial hypertension (PAH), defined as a systolic pulmonary artery pressure above 35 mm Hg, is another vascular disease entity recently described in patients receiving hemodialysis. It is a major problem due to its high prevalence and morbidity and mortality. Its pathophysiological mechanism is just known and the strategies for its supported not yet defined. AIMS: To determine the prevalence of PAH in our hemodialysis patients and its risk factors. METHODOLOGY: Single center descriptive and analytical cross-sectional study, including 111 hemodialysis patients who had benefit from a trans-thoracic cardiac Doppler ultrasound during 2014. A value greater than or equal to 35 mm Hg is considered PAH and classified as follows: mild PAH (35 50 mm Hg), moderate PAH (50 70 mm Hg), and severe pulmonary hypertension (> 70 mm Hg). Patients with a high probability of secondary PAH, especially those with the following history: chronic obstructive pulmonary disease, pulmonary embolism, were not included. RESULTS: The mean age was 44.3 ± 14.2 years. Among the 111 patients, 18 had pulmonary arterial pressure above 35 mm Hg corresponding to 16.22% of PAH prevalence. The average pressure was 45 mm Hg. Of these 18 patients, 11.8% had mild PAH, 3.4% moderate PAH and 0.8% severe PAH. The average hemodialysis duration was significantly associated with PAH (p = 0.003); as well as valvular calcification (p = 0.000), mitral regurgitation (p = 0.001) and tricuspid regurgitation (p = 0.002). CONCLUSION: Primary pulmonary hypertension is a major problem among our hemodialysis because of its high prevalence and its risk factors.