Development of IgA vasculitis with severe glomerulonephritis after COVID-19 vaccination: a case report and literature review

Abstract

With the worldwide spread of the COVID-19 vaccine program during the COVID-19 pandemic, the numbers of reported cases with new-onset or relapsed kidney disease/vasculitis such as minimal change nephrotic syndrome, immunoglobulinA (IgA) nephropathy, and IgA vasculitis (IgAV) that developed after COVID-19 vaccination are increasing. We present the case of a 67-year-old Japanese woman who developed IgAV with purpura on her extremities and trunk in the evening of the day that she received the second dose of the Pfizer-BioNTech COVID-19 vaccine. She subsequently presented with acute kidney injury and nephrotic syndrome, and a kidney biopsy performed 14 days after the second vaccination showed diffuse mesangial and endocapillary glomerulonephritis with necrotizing crescent formation, accompanied by IgA deposition. One steroid pulse plus four administrations of a monthly intravenous cyclophosphamide injection were applied, followed by oral azathioprine during oral steroid tapering. Her response to this treatment was unsatisfactory and intractable for some time. Eventually, her renal function improved and nephrotic syndrome was resolved, while microscopic hematuria and proteinuria at ~ 1 g/gCr remained at 6 months post-vaccination. Unlike the previous milder renal-involved IgAV cases following COVID-19 vaccination, our patient's case presented severe glomerulonephritis and took a long time to recover despite intensive initial immunosuppressive treatment.

IgA Vasculitis Following COVID-19 Vaccination: A French Multicenter Case Series Including 12 Patients

“…Baseline digestive and renal involvement were rare in our cohort, representing 33% and 17% of the cases. Of note, both in our study and in the literature, no life-threatening organ involvement was observed, with the exception of one patient, in literature, who presented with renal involvement during the course of IgAV requiring cyclophosphamide (19).…”

“…Hereby, we report the first case series including 12 patients who presented with IgAV following vaccination against COVID-19, providing similar data on both presentation and outcome regarding IgAV of other aetiology (18). So far, reports of IgAV following vaccination against COVID-19 were scarce (19). Of the 11 cases reported in adults, 9 were new onset vasculitis following vaccination and 2 were relapses of one previously proven and one presumed IgAV.…”

“…Interestingly, despite the low percentage of patients with digestive or renal involvement in our series, the proportion of patients treated with oral or intravenous corticosteroids was 75% vs. 50% in the literature. This finding illustrates the absence of harmonised worldwide guidelines for the treatment of adult IgAV patients (19), despite comparable IgAV severity profiles.…”

Sudden Onset of IgA Vasculitis Affecting Vital Organs in Adult Patients following SARS-CoV-2 Vaccines

“…They showed hematuria but did not present with proteinuria or significantly decreased renal function. The 20-40 mg/day of prednisolone or methylprednisolone was prescribed to the patients; two of them showed complete remission, and the data concerning the prognosis of the third patient was not available [12]. These documented cases suggest that the development of IgA vasculitis after COVID-19 vaccination is not limited to coincidence, and that the vaccines have the potential to trigger IgA vasculitis.…”

“…The relationship between these occurrences of IgA vasculitis following vaccination against COVID-19 dominantly favors correlation rather than coincidence, based on other cases which have been recently reported. There have been increasing reports of cases of IgA vasculitis that occurred after COVID-19 vaccination [7][8][9][10][11][12]. Table 2 summarizes the cases of new-onset or relapsed IgA vasculitis following COVID-19 vaccination by conducting a searching of the Pubmed as of 31 May 2022.…”