Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2024 Jan;19(1):13-37.
doi: 10.1007/s11739-023-03366-w. Epub 2023 Jul 27.

Henoch-schonlein purpura following exposure to SARS-CoV2 vaccine or infection: a systematic review and a case report

Federica Di Vincenzo  1   2 , Sara Ennas  1 , Marco Pizzoferrato  3 , Stefano Bibbò  1 , Serena Porcari  1 , Gianluca Ianiro  1   2 , Giovanni Cammarota  1   2
Affiliations
Case Reports

Henoch-schonlein purpura following exposure to SARS-CoV2 vaccine or infection: a systematic review and a case report

Federica Di Vincenzo et al. Intern Emerg Med. 2024 Jan.

Abstract

Background: Henoch-Schonlein purpura (HSP) is an IgA-mediated systemic small-vessel vasculitis (IgAV) that typically presents with a variable tetrad of symptoms. HSP if often preceded by respiratory tract infections, vaccinations, drugs or malignancies. During the recent COVID-19 pandemic multiples cases of HSP have been described after both infection and vaccination for SARS-CoV2. This study aims to perform a systematic review of literature and describe an additional complicated case of de-novo HSP appeared after the administration of the third dose of a mRNA-SARS-CoV2 vaccination.

Methods: Electronic bibliographic research was performed to identify all the original reports describing cases of de-novo HSP or IgAV appeared after respiratory infection or vaccine administration for SARS-CoV2. We included all case series or case reports of patients who respected our inclusion and exclusion criteria.

Results: Thirty-eight publications met our pre-defined inclusion criteria, for an overall number of 44 patients. All patients presented with palpable purpura variable associated with arthralgia, abdominal pain or renal involvement. Increased levels of inflammation markers, mild leukocytosis and elevated D-dimer were the most common laboratory findings. Up to 50% of patients presented proteinuria and/or hematuria. Almost all skin biopsies showed leukocytoclastic vasculitis, with IgA deposits at direct immunofluorescence in more than 50% of cases.

Conclusions: Our results suggest that the immune response elicited by SARS-CoV2 vaccine or infection could play a role in the development of HSP. Current research suggests a possible role of IgA in immune hyperactivation, highlighted by early seroconversion to IgA found in some COVID-19 patients who develop IgA vasculitis.

Keywords: Henoch–Schonlein purpura; IgA-mediated vasculitis; SARS-CoV2 infection; SARS-CoV2 vaccination.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Fig. 1
Fig. 1
a Multiple purpuric lesions. The rash was palpable, non-pruritic, non-blanching; b Patient’s feet rash, characteristic of Henoch–Schonlein purpura
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Ruperto N, Ozen S, Pistorio A, et al. EULAR/PRINTO/PRES criteria for Henoch-Schonlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood takayasu arteritis: ankara 2008. Part I: overall methodology and clinical characterisation. Ann Rheum Dis. 2010;69:790–797. doi: 10.1136/ard.2009.116624. - DOI - PubMed
    1. Leung AKC, Barankin B, Leong KF. Henoch-schönlein purpura in children: an updated review. Curr Pediatr Rev. 2020;16:265–276. doi: 10.2174/1573396316666200508104708. - DOI - PubMed
    1. Ofori E, Ramai D, Ona MA, et al. Adult-onset henoch-schonlein purpura duodenitis. J Clin Med Res. 2017 doi: 10.14740/jocmr3181w. - DOI - PMC - PubMed
    1. Piram M, Maldini C, Biscardi S, et al. Incidence of IgA vasculitis in children estimated by four-source capture–recapture analysis: a population-based study. Rheumatology. 2017;56:1358–1366. doi: 10.1093/rheumatology/kex158. - DOI - PubMed
    1. Trapani S, Micheli A, Grisolia F, et al. Henoch schonlein purpura in childhood: epidemiological and clinical analysis of 150 cases over a 5-year period and review of literature. Semin Arthritis Rheum. 2005;35:143–153. doi: 10.1016/j.semarthrit.2005.08.007. - DOI - PubMed