An Additional Case of Minimal Change Disease Following the Pfizer-BioNTech COVID-19 Vaccine

To the Editor:

A recent case report by Lebedev et al¹ described a patient presenting with minimal change disease (MCD) within days of his first injection of the BNT162b2 vaccine (Pfizer-BioNTech mRNA-based vaccine against severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]).¹ Here, we describe a similar case of a patient with new-onset MCD after this vaccine.

A man in his early 80s was admitted with a 2-week history of edema and increase of body weight of 12 kg. He had received the first injection of the Pfizer-BioNTech COVID-19 (coronavirus disease 2019) vaccine 7 days before onset of edema. His medical history mentioned venous thromboembolisms several years earlier. He used no medication. Blood pressure was 168/94 mm Hg, and physical examination showed generalized pitting edema including periorbital edema. Blood tests revealed serum creatinine, 1.43 mg/dL; albumin, 1.03 g/dL; and total cholesterol, 522 mg/dL. Proteinuria was 15.3 g/d. Additional studies revealed no signs of an underlying systemic disease or malignancy. Light microscopy of a kidney biopsy specimen showed no apparent abnormalities in all 23 glomeruli examined. Tubular epithelial cells showed prominent nuclei and vacuolization. Immunofluorescence studies were negative. Electron microscopy showed diffuse podocyte foot-process effacement. All findings were consistent with MCD. Treatment with prednisolone 80 mg daily was initiated. After 10 days of prednisolone treatment, urinary protein-creatinine ratio declined to 0.68 g/g and edema had disappeared.

Our case provides support for a potential association between the BNT162b2 vaccine and onset of MCD. Pharmacovigilance of COVID-19 vaccines will be important to determine the incidence of this potential adverse event.