IgA Vasculitis Associated With COVID-19

Abstract

IgA vasculitis, also known as Henoch-Schonlein Purpura (HSP), is an inflammatory disorder of small blood vessels that can present with palpable purpura, arthralgias, abdominal pain, and kidney disease. It is most commonly found in pediatric patients after an inciting infection but has been seen across all ages and associated with certain drugs and vaccines. COVID-19 has been associated with various cutaneous manifestations, but HSP is a rarely reported one. We present a case of a 21-year-old female presenting with a petechial rash found to be seronegative IgA vasculitis presenting concurrently with dyspnea secondary to COVID-19. She was initially seen by an outside practitioner, tested negative for COVID, and was prescribed a course of oral prednisone. Shortly thereafter, she visited the ED for worsening shortness of breath and tested positive for COVID-19, for which she received Paxlovid. Biopsy after a visit to a dermatologist confirmed intramural IgA deposition on immunofluorescence, and she was tapered off prednisone and started on azathioprine.

An Investigation of the Relationship between Henoch-Schönlein Purpura and Viral Infection in Korea Using the Health Insurance Database

“…In their study, IFV and rotavirus were significantly associated with the development of HSP in children up to 18 years of age. HRSV, IFV, and norovirus were associated with HSP in early childhood (ages 2-5), IFV and norovirus in middle childhood (ages 6-11), and bocavirus and rotavirus in adolescence (ages [12][13][14][15][16][17][18].…”

“…Additionally, during the coronavirus pandemic, there were many case reports showing that the infection caused by SARS-CoV-2 was associated with the occurrence of HSP [ 6 , 7 , 8 ]. Furthermore, IgA vasculitis has been documented following coronavirus disease (COVID-19) vaccination [ 9 , 10 , 11 , 12 , 13 ]. To determine the correlation between respiratory and gastrointestinal viruses and HSP incidence, we studied the public health data provided by the Korea Disease Control and Prevention Agency (KDCA) and the Health Insurance Review and Assessment (HIRA) Open Access Big Data Platform.…”

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].…”

Case report: Henoch‐Schonlein purpura complicated by pathergy phenomenon

“…Recently, even COVID-19 infection and immunizations have also been associated with IGAV. 3,4 HSP in children has been extensively studied, however, in adults, it has been studied to a limited extent. Adults have a more systemic involvement along with a lot of atypical manifestations of HSP.…”