IgA Vasculitis Following COVID-19 Vaccination

Abstract

As new variants of SARS-CoV-2 continue to emerge worldwide, countries are striving to fully vaccinate their population in a bid to prevent severe disease, subsequent hospitalizations, and the associated strain on their healthcare systems and death. In this context, there is growing evidence of rare, potential side effects associated with COVID-19 vaccines. IgA vasculitis is a systemic, IgA-mediated vasculitis characterized by palpable purpura, arthralgia, abdominal pain, and renal involvement. It is the most common type of vasculitis in childhood, sporadically affecting the adult population. However, there have been multiple reports of IgA vasculitis following vaccination against COVID-19. Herein, we present the case of a 72-year-old patient with palpable purpura that developed two weeks after receiving the Pfizer BioNTech vaccine. Laboratory investigations revealed elevated serum creatinine (2.6 mg/dL), macroalbuminuria (8.6 g/24 h), and macroscopic hematuria. Histopathological examination confirmed necrotizing vasculitis, and a diagnosis of IgA vasculitis was established. Considering the clinical presentation, the laboratory and histopathological findings, and the time interval between the vaccination and the development of symptoms, we strongly believe that IgA vasculitis in this patient arose as a side effect of the Pfizer BioNTech vaccine.

Keywords: adult; autoimmunity; covid-19; iga vasculitis; vaccine.

Figure 1. Palpable purpura. Dark red and purple, elevated, firm, confluent round papules in the lower limbs with signs of erosion and necrosis.

Figure 2. Leukocytoclastic vasculitis (H&E staining) The vessel walls are thickened due to adipose tissue and fibrin deposits, as well as the presence of diffuse lymphoplasmacytic and neutrophilic infiltrates. Presence of endothelial edema, extravasated RBCs, and polymorphonuclear inflammatory cells involving the superficial dermis layer.

Figure 3. Leukocytoclastic vasculitis (H&E staining) The vessel walls are thickened due to adipose tissue and fibrin deposits, as well as the presence of diffuse lymphoplasmacytic and neutrophilic infiltrates. Presence of endothelial edema, extravasated RBCs, and polymorphonuclear inflammatory cells involving the superficial dermis layer.

Figure 4. Leukocytoclastic vasculitis (immunohistochemistry). Positive immunohistochemistry testing for IgA.

Figure 5. Leukocytoclastic vasculitis (immunohistochemistry). Positive immunohistochemistry testing for IgA.

Figure 6. The purpuric rash following corticosteroid treatment.