Possible association between IgA vasculitis and COVID ‐19

Abstract

a 22 years male developed fever, pain abdomen, vomiting, and painful swelling of both ankle and wrist joints. Two days later, he noticed multiple red raised lesions symmetrically over all extremeries. Nasopharyneal swab for Coronavirus disease 2019 (COVID-19) PCR testing was positive at admission. He had no respiratory symptoms. Examination revealed fever (100.8 F), edema with tenderness over both wrist, hand and ankle joints. Cutaneous examination revealed multiple, discrete to confluent palpable purpura with few central vesicles distributed symmetrically over all extremities, gluteal region, and lower abdomen (Figure 1A-D). He denied history of any drug intake prior to onset of symptoms.The patient was investigated on the lines of IgA vasculitis and systemic involvement of COVID-19. Urinalysis revealed a proteinuria of 2 g/day. Remaining investigations were as in Table 1. Skin biopsy from thigh lesion revealed features of leukocytoclastic vasculitis (Figure 2A,B). Direct immunofluorescence (DIF) from lesion was negative which could be due to biopsy from a lesion >48 h duration or sample processing error. PCR for SARS-CoV-2 from skin sample could not be done due to nonavailability. Because of the proteinuria, a kidney biopsy was done which showed features of focal necrotizing, mesangial, and focal endocapillary proliferative IgA nephropathy with mesangial granular deposits of IgA (Figure 3). Patient was promptly started on injection dexamethasone equivalent to 1 mg/kg of prednisolone for 10 days and shifted to oral prednisolone subsequently. Presence of poor prognostic findings on kidney biopsy with glomerular segmental tuft necrosis and cellular crescent formation prompted us to plan long-term immunosuppressants for at least three months duration. Hence, mycophenolate mofetil as steroid sparing agent was added to be continued for three months and oral prednisolone tapered off in one month. His cutaneous lesions, joint involvement and abdominal symptoms resolved, liver function tests, and urinalysis normalized over 2 weeks. The patient is under follow-up to look for long-term renal complications.

Rheumatological complications of Covid 19

“…Recently, four cases have highlighted SARS-CoV-2 as a trigger for IgA vasculitis, three of which had renal involvement [ [131] , [132] , [133] , [134] ]. Anti- SARS-CoV-2 IgA is the first immunoglobulin to be detected in COVID-19 as early as 2 days after onset [ 135 ].…”

Henoch-Schönlein Purpura Following the First Dose of COVID-19 Viral Vector Vaccine: A Case Report

“…HSP has been observed in the setting of numerous infections and after the administration of several vaccines, including those against influenza, pneumococcal disease, rabies, hepatitis B virus, and meningococcal disease [14,15]. To date, several cases of HSP after SARS-CoV-2 infections are described in the literature [4,[16][17][18][19][20][21][22][23][24][25][26][27][28]. Recently, Obeid et coll.…”

IgA Vasculitis: Etiology, Treatment, Biomarkers and Epigenetic Changes

“…Interestingly, several studies have reported COVID-19 associated IgA vasculitis [ 71 , 72 , 73 , 74 , 75 , 76 , 77 ]. COVID-19 caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the COVID-19 pandemic is currently an ongoing global problem and is known to cause vasculitislike syndromes [ 78 ].…”