New-onset kidney biopsy-proven IgA vasculitis after receiving mRNA-1273 COVID-19 vaccine: case report

Abstract

As mRNA COVID-19 vaccines have become widely available, cases of new-onset glomerular disease after receiving COVID-19 vaccination have been reported. Here, we present a case of kidney biopsy-proven new-onset IgA vasculitis after receiving the mRNA-1273 (Moderna) COVID-19 vaccination. A 47-year-old man with a 10-year medical history of hypertension and hyperuricemia visited our hospital 19 days after receiving an initial mRNA-1273 COVID-19 vaccine injection for purpuric eruption on the legs and dorsal regions of the feet. Although the eruptions spontaneously improved within 5 days, they developed again at 15 days after the second injection. A histopathological examination of skin biopsy specimens was reminiscent of leukocytoclastic vasculitis, though direct immunofluorescence did not indicate IgA deposition within small vessel walls. Urinalysis indicated severe proteinuria (3 +) and occult blood (3 +). Thus, a kidney biopsy was performed and light microscopy revealed mild mesangial expansion, hypercellularity, and endocapillary hypercellularity, with cellular and fibrocellular crescents observed in three and one, respectively, of a total of 15 glomeruli. Immunofluorescence also showed diffuse granular mesangial staining (3 +) for IgA. Histopathological features were consistent with IgA vasculitis. Intravenous methylprednisolone at 1000 mg for 3 days was initiated, followed by oral prednisolone (0.6 mg/kg/day). Over the following 2-week period, serum creatinine level improved from 1.24 to 1.06 mg/dL and proteinuria decreased from 2.98 to 0.36 g/g Cr, though occult blood persisted. Findings in the present case indicate that new-onset IgA vasculitis after receiving mRNA-1273 COVID-19 vaccine can be treated with corticosteroid therapy.

Coronavirus disease 2019, vaccination against coronavirus and immunoglobulin A-mediated diseases: systematic literature review

“…In the second selection round, full-text articles of the remaining papers were assessed. For the final analysis, we retained 67 reports [ [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , <...…”

“…Data are presented as frequency or as median with interquartile range. All Berger Glomerulo-nephritis Henoch-Schönlein Vasculitis P-value N 87 47 40 Males: females, N 45:40 20 : 25 25 : 15 0.128 Age years 34[ [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] ] 35 [ [19] , [20] , [21] , [22] , [23] , [24] ...…”

“…Data are presented as frequency or as median with interquartile range. Vaccination-associated Infection-associated P-value N 17 23 Males: females, N 9:8 16 : 7 0.503 Age, years of age 60 [ [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] ] 13 [ [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , …”

“…Following databases were used: Google Scholar, Excerpta Medica and the United States National Library of Medicine. Eighty-seven patients with immunoglobulin A-mediated diseases associated with SARS-CoV-2 infection or vaccination against it were sorted out (53% males, 47% females; 34 (Morisawa and Honda, 2022; Negrea and Rovin, 2021; Niel and Florescu, 2022; Okada et al, 2022; Park et al, 2021; Perrin et al, 2021; Plasse et al, 2021; Rahim et al, 2021; Srinivasan et al, 2022; Tan et al, 2021; Udagawa and Motoyoshi, 2022; Watanabe et al, 2022; Yokote et al, 2022; Apaydın et al, 2021; Huang et al, 2020; Pérez et al, 2021; Badier et al, 2021; Ball-Burack and Kosowsky, 2021; Bostan et al, 2021; Chandwar et al, 2022; Fritzen et al, 2022; Grossman et al, 2021; Hines et al, 2021; Iwata et al, 2021; Kondo and Yamanaka, 2021; Maye et al, 2021; Mohamed et al, 2021; Naitlho et al, 2021; Nakatani et al, 2022; Obeid et al, 2021; Oniszczuk et al, 2021; Park et al, 2021; Sirufo et al, 2021; Al Haji et al, 2021; Al Ghoozi and AlKhayyat, 2021) [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] 17-51 years of age, median and interquartile range): 47 cases of Berger glomerulonephritis and 40 of Henoch-Schönlein vasculitis. Approximately 50% (N = 24) of Berger glomerulonephritis and 10% (N = 4) of Henoch-Schönlein vasculitis patients presented with a pre-existing history of immunoglobulin A-mediated disease.…”

New-onset and relapse of nephrotic syndrome following COVID-19 vaccination: a questionnaire survey in Japan

“…Recently, several studies have reported the incidence of new-onset and relapse of nephrotic syndrome (NS) following COVID-19 vaccination in patients with glomerular diseases, especially those with minimal change disease (MCD) [ 8 – 14 ]. Furthermore, several studies have reported the incidence of gross hematuria following COVID-19 vaccination in patients with immunoglobulin A nephropathy (IgAN) [ 15 – 17 ] and IgA vasculitis [ 18 ]. Most recently, a clinical survey of gross hematuria associated with COVID-19 vaccination using a web-based questionnaire in Japan reported the clinical features of gross hematuria in 27 patients following COVID-19 vaccination [ 19 ].…”