Adult-Onset IgA Vasculitis Associated With Pulmonary-Renal Syndrome Following COVID-19 Infection: A Case Report and Literature Review

Abstract

Immunoglobulin A (IgA) vasculitis, also known as Henoch-Schönlein purpura (HSP), is an immune complexmediated inflammation of small blood vessels that leads to tissue destruction with or without organ damage. We described a case of a 41-year-old otherwise healthy female who presented with an ascending rash distributed on both lower extremities and arthralgia. Blood testing revealed high blood urea nitrogen (BUN), creatinine, and inflammatory markers, as well as a negative autoimmune panel. Urinalysis revealed proteinuria and hematuria. A kidney biopsy was performed, which revealed abnormalities. She was started on intravenous (IV) methylprednisolone pulse therapy. Suddenly, she complained of epistaxis and became desaturated. Computed tomography revealed bilateral pleural effusion, and she was transferred to the ICU. Bronchoalveolar lavage was performed and was consistent with an increasing bloodier return. Plasma exchange was performed. The rash and clinical symptoms improved dramatically. This study reports a case of IgA vasculitis based on The European Alliance of Associations for Rheumatology/Pediatric Rheumatology International Trials Organization/Pediatric Rheumatology European Society (EULAR/PRINTO/PRES) criteria associated with pulmonary-renal syndrome following a case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Mortal Dangers of Adult-Onset IgA Vasculitis

“…For example, recently, there have been reports on post-COVID-19 viral infections and their relations to IgAV. Two adult-onset post-COVID IgAV cases reported similar petechial lesions and palpable purpura presentations; however, they both survived with the usage of corticosteroids [5,6]. On the basis of treatment, one case utilized further azathioprine whereas the other used intravenous immunoglobulin and plasma exchange [5,6].…”

“…Two adult-onset post-COVID IgAV cases reported similar petechial lesions and palpable purpura presentations; however, they both survived with the usage of corticosteroids [5,6]. On the basis of treatment, one case utilized further azathioprine whereas the other used intravenous immunoglobulin and plasma exchange [5,6]. One multi-center randomized trial demonstrated that the addition of cyclophosphamide to corticosteroids did not improve disease remission nor active visceral involvement when compared to corticosteroids alone for treatment [7].…”