Hepatic and pulmonary involvement in a patient with PR3-ANCA vasculitis following SARS-CoV-2 vaccination: a case report.

We here report the first case of anti-proteinase 3 (PR3) positive ANCA-associated vasculitis following SARS-CoV-2 Pfizer-BioNTech vaccine presenting with prominent liver involvement and alveolar hemorrhage. Two weeks after vaccination, a 49-year-old man developed inflammatory arthralgias and hypertransaminasemia. Two months later, fever and hemoptysis appeared; the patient tested positive for anti-PR3 autoantibodies. High dose steroids and rituximab were started, and complete remission was achieved. Systemic autoimmune diseases, including ANCA-associated vasculitis, should always be considered in the differential diagnosis of hypertransaminasemia, especially when the clinical context is suspicious.