Immunoglobulin A vasculitis post-severe acute respiratory syndrome coronavirus 2 vaccination and review of reported cases

Abstract

Immunoglobulin (Ig)A vasculitis/nephropathy is a systemic immune complex-mediated vasculitis. Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination is widely recommended in individuals without specific allergy to the vaccine components, it is arguable whether vaccination is advisable for patients with IgA vasculitis or for predisposed individuals. We and others have presented cases of IgA vasculitis occurring after SARS-CoV-2 vaccination. In total, these 19 cases, including ours, involved predominantly female patients, and half of them were suffering from de novo vasculitis onset. The most frequent manifestation was gross hematuria (89.5%) while skin lesions were relatively infrequent, occurring in only five cases (26.3%), of which three (15.8%) were confirmed to be IgA vasculitis. Taken together, these cases suggest that SARS-CoV-2 vaccination might be a trigger for development/deterioration of IgA vasculitis/nephropathy.

Keywords: de novo onset; deterioration; immunoglobulin A nephropathy; immunoglobulin A vasculitis; severe acute respiratory syndrome coronavirus 2 vaccination.

FIGURE 1

Palpable purpura of legs

FIGURE 2

Histological and immunofluorescent features of skin lesions of the right leg. (a) Hematoxylin–eosin staining (original magnification × 200). (b) Fluorescein isothiocyanate‐conjugated anti‐immunoglobulin A antibody (× 200)