Vasculitis flare after COVID-19: report of two cases in patients with preexistent controlled IgA vasculitis and review of the literature

Valero, Cristina; Baldivieso-Achá, Juan Pablo; Uriarte, Miren; Vicente-Rabaneda, Esther F.; Castañeda, Santos; García‐Vicuña, Rosario

doi:10.1007/s00296-022-05153-w

Cited by 19 publications

(12 citation statements)

References 46 publications

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“…Renal involvement with biopsy-proven focally crescentic and segmentally necrotizing IgA nephropathy [ 20 ] or renal function deterioration requiring immunosuppressive therapy have been reported [ 21 ]. Interestingly, antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis has also been reported in subjects with previously controlled HSP after COVID-19 infection [ 22 ]. A review showed that COVID-19-associated HSP affects mostly adults, and the concomitant presence of other diseases led to a more severe course of vasculitis in older patients developing acute renal failure [ 23 ].…”

Section: Environment Microbial and Virus Infectionsmentioning

confidence: 99%

Viral Infections May Be Associated with Henoch–Schönlein Purpura

Nikolaishvili

Pazhava

Lernia

2023

JCM

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Henoch–Schönlein purpura or IgA vasculitis is the most common type of pediatric vasculitis that may affect adults as well. It is classified as a type of small-vessel vasculitis. It can cause cutaneous and systemic symptoms with a minority of patients developing kidney failure. Little is known about the specific pathophysiology of this disorder, except that it is believed to occur in individuals with abnormally glycosylated IgA1. Serum aberrant IgA1 may form large antigen–antibody complexes which, due to a defective clearance, are able to deposit in the small vessels of the skin, kidney, gut, and joints. A variety of factors, including infectious agents, drugs, and vaccines, have been identified as potential triggers. The majority of cases are preceded by upper respiratory tract infections, and seasonal variations suggest a link with many pathogens. The etiologic agent most frequently associated with IgA vasculitis historically have been group A β-hemolytic streptococcus and common respiratory tract viruses. However, during the current coronavirus pandemic, SARS-CoV-2 infection was identified as a main trigger factor. In addition, IgA vasculitis has been observed following COVID-19 immunization. This review provides insights into the state of the art on the relationship between viral infections, viral vaccines, and Henoch–Schönlein purpura.

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Section: Environment Microbial and Virus Infectionsmentioning

confidence: 99%

Viral Infections May Be Associated with Henoch–Schönlein Purpura

Nikolaishvili

Pazhava

Lernia

2023

JCM

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“…It should be pointed out that some studies support that SARS-CoV-2 has been linked to IgAV. The mechanisms involved in SARS-CoV-2 regulation of autoantibody generation, faulty development of Th2 response, endothelial inflammation and dysfunction, complement activation, NET production, and the upregulation of proinflammatory cytokines such as interleukin 6 may lead to vasculitis ( 125 – 127 ). The contradiction between the reduction in IgAV cases and the possible trigger may arise from the fact that SARS-CoV-2 may not be as strong a trigger as the other cold viruses or bacteria for IgAV.…”

Section: Pathogenesismentioning

confidence: 99%

IgA vasculitis update: Epidemiology, pathogenesis, and biomarkers

2022

Front. Immunol.

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Immunoglobulin A vasculitis (IgAV), formerly known as Henoch-Schönlein purpura, is the most common systemic vasculitis in children, characterized by diverse clinical manifestations with a wide spectrum ranging from isolated cutaneous vasculitis to systemic involvement. The incidence of IgAV is geographically and ethnically variable, with a prevalence in autumn and winter, suggesting a driving role that genetic and environmental factors play in the disease. Although IgAV has a certain degree of natural remission, it varies widely among individuals. Some patients can suffer from severe renal involvement and even progress to end-stage renal disease. Its pathogenesis is complex and has not been fully elucidated. The formation of galactose-deficient IgA1 (Gd-IgA1) and related immune complexes plays a vital role in promoting the occurrence and development of IgAV nephritis. In addition, neutrophil activation is stimulated through the binding of IgA to the Fc alpha receptor I expressed on its surface, resulting in systemic vascular inflammation and tissue damage. Starting from the epidemiological characteristics, this article will review the role of immunological factors such as Gd-IgA1, autoantibodies, circulating immune complexes, complement system, cellular immunization, and the contributions of environmental and genetic factors in the pathogenesis of IgAV, and conclude with the major biomarkers for IgAV.

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“…All these patients received systemic CS. Biologics and immunosuppressants were administered only in 4 individuals due to concomitant renal impairment (1 rituximab, 2 mycophenolate mofetil, 1 cyclophosphamide), with a favorable response across published reports ( 28 ).…”

Section: Covid-19-associated Cutaneous Vasculitis/vasculopathymentioning

confidence: 99%

Cutaneous vasculitis and vasculopathy in the era of COVID-19 pandemic

et al. 2022

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Cutaneous vasculitides encompass a heterogeneous group of clinicopathological entities, which may occur as single-organ vasculitis of the skin or present as skin-limited variant of systemic vasculitis (i.e., skin-limited ANCA-associated vasculitis), and are triggered by various factors, including infections, drugs and vaccines. The COVID-19 pandemic has challenged us with a variety of both disease- and vaccine-associated skin manifestations, including vasculitis. Among the latter, cutaneous small-vessel vasculitis, previously known as leukocytoclastic vasculitis, seems to be the most reported in either scenario, i.e., natural infection and vaccination. Vasculopathy without true vasculitic changes on histology develops in but a minority of cases, mostly severe/critical COVID-19 patients, and appears to be the result of endothelial injury due to pauci-immune thromboembolic mechanisms. Herein, we provide an overview of the available literature on COVID-19-associated and anti-SARS-CoV-2-vaccine-associated cutaneous vasculitis. Although evidence is mostly limited to isolated reports, with a proportion of cases lacking histopathological confirmation, ample overlap with pre-pandemic forms is shown.

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Vasculitis flare after COVID-19: report of two cases in patients with preexistent controlled IgA vasculitis and review of the literature

Cited by 19 publications

References 46 publications

Viral Infections May Be Associated with Henoch–Schönlein Purpura

Viral Infections May Be Associated with Henoch–Schönlein Purpura

IgA vasculitis update: Epidemiology, pathogenesis, and biomarkers

Cutaneous vasculitis and vasculopathy in the era of COVID-19 pandemic

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