Henoch-Schonlein purpura in a renal transplant recipient with prior IgA nephropathy following influenza vaccination

Abstract

Henoch–Schönlein purpura (HSP) is a systemic small-vessel leucocytoclastic vasculitis with deposition of immune complexes containing Immunoglobulin A (IgA). IgA Nephropathy (IgAN) is a glomerulonephritis caused by mesangial deposition of IgA. The onset of HSP, but not IgAN, has been linked to influenza vaccination.We report the first case of HSP with glomerular involvement, in a renal transplant recipient following influenza vaccination. The patient had prior end-stage renal failure (ESRF) secondary to IgAN, without clinical evidence of IgAN recurrence after transplantation. This is of clinical relevance as influenza vaccination is regarded safe, effective, and recommended after renal transplantation.Nephrologists should be aware of the potential for influenza vaccination to have adverse effects in renal transplant recipients, especially if the primary renal disease is HSP or IgAN.

IgA Vasculitis and IgA Nephropathy: Same Disease?

“…Many, rather old, clinical cases have been published. They describe episodes of one or the other disease within the same siblings, in particular in homozygous twins [ 1 ], simultaneously or successively [ 2 ], in a father and son [ 3 ], in the same patient at two periods of his life [ 4 , 5 , 6 , 7 ] and, more recently, recurrences in kidney allograft in one form or another [ 8 , 9 , 10 ].…”

Reactivation of IgA vasculitis after COVID-19 vaccination

“…IgA vasculitis flares following vaccinations have been reported previously. 2 Furthermore, it has been reported that patients with IgA nephropathy have a stronger IgA response to intramuscular influenza vaccine than do healthy controls. 3 Moreover, two reports have described three cases of haematuria and IgA nephropathy flares following the second dose of mRNA COVID-19 vaccines in three individuals with biopsy-proven IgA nephropathy, two patients following the mRNA-1273 vaccine, 4 and one after the BNT162b2 (BioNTech-Pfizer) vaccine.…”

A case of gross hematuria and IgA nephropathy flare-up following SARS-CoV-2 vaccination

“…The IgAN flare in our patient following the second SARS-CoV-2 vaccine dose without known prior exposure to SARS-CoV-2 suggests it was mediated by a delayed-type hypersensitivity reaction. Vasculitis flare-ups following vaccinations have been reported in the past 2 , 3 .…”