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Alsubaie A, Alshabanat A, Almizel A, Omair M, Alodaini R. A 20-Year-Old Man with IgA Vasculitis following COVID-19 Vaccination. Case Rep Rheumatol 2023; 2023:9505383. [PMID: 37492803 PMCID: PMC10365908 DOI: 10.1155/2023/9505383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/04/2023] [Accepted: 06/21/2023] [Indexed: 07/27/2023] Open
Abstract
IgA vasculitis is a common type of vasculitis that is generally triggered by infectious causes. Vaccines have been reported as a trigger as well. Herein, we report a case of a young man who is previously healthy and who developed IgA vasculitis after the first dose of the COVID-19 mRNA vaccine Pfizer-BioNTech. The patient's symptoms were mainly skin and joint without renal or other system involvement. The patient had an excellent outcome with complete resolution after treatment with steroid tapering and azathioprine as a steroid-sparing agent over 6 months.
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Affiliation(s)
- Abdulaziz Alsubaie
- King Saud University College of Medicine, Department of Infectious Diseases, Riyadh, Saudi Arabia
| | - Abdulmajeed Alshabanat
- King Saud University College of Medicine, Department of Internal Medicine, Riyadh, Saudi Arabia
| | | | - Mohammed Omair
- King Saud University College of Medicine, Department of Internal Medicine, Riyadh, Saudi Arabia
| | - Rahaf Alodaini
- King Saud University College of Medicine, Department of Internal Medicine, Riyadh, Saudi Arabia
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Nishimura N, Shiomichi Y, Takeuchi S, Akamine S, Yoneda R, Yoshizawa S. IgA vasculitis following COVID-19 vaccination. Mod Rheumatol Case Rep 2023; 7:122-126. [PMID: 35253880 PMCID: PMC8903512 DOI: 10.1093/mrcr/rxac014] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/24/2021] [Accepted: 02/11/2022] [Indexed: 01/07/2023]
Abstract
Immunoglobulin A (IgA) vasculitis is generally triggered by infectious causes, but it has also been reported after immunisation with various vaccines. Herein, we report two cases of IgA vasculitis after receiving the first or second dose of the Pfizer-BioNTech BNT16B2b2 mRNA vaccine. Two men, aged 22 and 30 years, developed palpable purpura on the extremities and arthritis. One patient also complained of fever and gastrointestinal symptoms. Laboratory findings revealed mild leucocytosis and slightly elevated C-reactive protein levels, although the platelet count and coagulation profile were within normal levels in both cases. Proteinuria and microhaematuria were seen in one patient. Skin biopsies were performed in both patients and revealed leucocytoclastic vasculitis. The deposits of IgA and C3 were shown in immunofluorescence studies in one patient. Both patients were diagnosed with IgA vasculitis and treated with prednisolone, and their symptoms resolved within 1 week after initiation of treatment. The coronavirus disease 2019 mRNA vaccine could trigger IgA vasculitis; however, a coincidence cannot be ruled out.
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Affiliation(s)
- Naoya Nishimura
- Department of Rheumatology, Hamanomachi Hospital, Fukuoka, Japan
| | | | | | - Shun Akamine
- Department of Pathology, Hamanomachi Hospital, Fukuoka, Japan
| | - Reiko Yoneda
- Department of Pathology, Hamanomachi Hospital, Fukuoka, Japan
| | - Seiji Yoshizawa
- Department of Rheumatology, Hamanomachi Hospital, Fukuoka, Japan
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Chomičienė A, Černiauskas K, Linauskienė K, Meškauskas R, Malinauskienė L. Two case reports of skin vasculitis following the COVID-19 immunization. Open Med (Wars) 2022; 17:1944-1948. [PMID: 36561846 PMCID: PMC9743192 DOI: 10.1515/med-2022-0608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 12/14/2022] Open
Abstract
The coronavirus 2019 (COVID-19) disease is now responsible for one of the most challenging and concerning pandemics. Since December 2020, the world has had access to COVID-19 prophylaxis; thus, we encounter adverse events from vaccination more often due to the vast vaccination range. We present two case reports of difficult-to-treat skin vasculitis due to COVID-19 vaccination that were successfully treated in a tertiary-level university hospital. When encountering systemic treatment, resistant skin vasculitis plasmapheresis could be a choice of treatment.
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Affiliation(s)
- Anželika Chomičienė
- Vilnius University, Medical Faculty, Institute of Clinical Medicine, Clinic of Chest Diseases, Immunology and Allergology, Department of Pulmonology and Allergology, Vilnius, Lithuania
| | - Kęstutis Černiauskas
- Vilnius University, Medical Faculty, Institute of Clinical Medicine, Clinic of Chest Diseases, Immunology and Allergology, Department of Pulmonology and Allergology, Vilnius, Lithuania
| | - Kotryna Linauskienė
- Vilnius University, Medical Faculty, Institute of Clinical Medicine, Clinic of Chest Diseases, Immunology and Allergology, Department of Pulmonology and Allergology, Vilnius, Lithuania,Vilnius University Hospital Santaros Klinikos, Department of Pulmonology and Allergology, Santariškių Str. 2, Vilnius LT-08661, Lithuania
| | - Raimundas Meškauskas
- Pathology Department, National Center of Pathology, Affiliate of Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Laura Malinauskienė
- Vilnius University, Medical Faculty, Institute of Clinical Medicine, Clinic of Chest Diseases, Immunology and Allergology, Department of Pulmonology and Allergology, Vilnius, Lithuania
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Montorfani-Janett VML, Montorfani GE, Lavagno C, Gualco G, Bianchetti MG, Milani GP, Lava SAG, Cristallo Lacalamita M. External Male Genitalia in Henoch-Schönlein Syndrome: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9081154. [PMID: 36010045 PMCID: PMC9406875 DOI: 10.3390/children9081154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/16/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022]
Abstract
The external genitalia are notoriously implicated in every fifth male with Henoch−Schönlein syndrome. Nonetheless, the underlying conditions are poorly categorized. To characterize the involvement of the external male genitalia in this vasculitis, we performed a systematic review of the literature. For the final analysis, we selected 85 reports published between 1972 and 2022, which reported on 114 Henoch−Schönlein cases (≤ 18 years, N = 104) with a penile (N = 18), a scrotal (N = 77), or both a penile and a scrotal (N = 19) involvement. The genital involvement mostly appeared concurrently with or after the cutaneous features of Henoch−Schönlein syndrome, while it preceded the presentation of Henoch−Schönlein syndrome in 10 cases. Patients with penile involvement (N = 37) presented with swelling (N = 26), erythema (N = 23), and purpuric rash (N = 15). Most patients were otherwise asymptomatic except for transient micturition disorders (N = 2) or priapism (N = 2). Patients with scrotal involvement (N = 96) presented with pain (N = 85), swelling (N = 79), erythema (N = 42), or scrotal purpura (N = 22). The following scrotal structures were often involved: scrotal skin (N = 83), epididymis (N = 49), and testes (N = 39). An ischemic testicular damage was noted in nine patients (four with torsion and five without). The scrotal skin involvement was mostly bilateral, while that of the epididymis and testis were mostly (p < 0.0001) unilateral (with a significant predilection for the left side). In conclusion, this analysis allows for better categorization of the involvement of external male genitalia in Henoch−Schönlein vasculitis. Scrotal involvement can result from skin inflammation, epididymitis, orchitis, or testicular ischemia.
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Affiliation(s)
- Valentina M. L. Montorfani-Janett
- Family Medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland; (V.M.L.M.-J.); (G.E.M.); (M.G.B.)
| | - Gabriele E. Montorfani
- Family Medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland; (V.M.L.M.-J.); (G.E.M.); (M.G.B.)
| | - Camilla Lavagno
- Pediatric Emergency Department, University Children’s Hospital Zurich, 8032 Zurich, Switzerland;
| | - Gianluca Gualco
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland;
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Mario G. Bianchetti
- Family Medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland; (V.M.L.M.-J.); (G.E.M.); (M.G.B.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Gregorio P. Milani
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Sebastiano A. G. Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois and University of Lausanne, 1011 Lausanne, Switzerland
- Heart Failure and Transplantation, Department of Paediatric Cardiology, Great Ormond Street Hospital, London WC1N 3JH, UK
- Correspondence:
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Grossman ME, Appel G, Little AJ, Ko CJ. Post-COVID-19 vaccination IgA vasculitis in an adult. J Cutan Pathol 2021; 49:385-387. [PMID: 34779011 PMCID: PMC8652641 DOI: 10.1111/cup.14168] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/31/2021] [Accepted: 11/09/2021] [Indexed: 12/15/2022]
Abstract
Leukocytoclastic vasculitis has been reported in the setting of COVID‐19 infection and post‐COVID‐19 vaccination. We report a case of IgA vasculitis (IgAV) post‐COVID‐19 vaccination, with immunoglobulin A (IgA) immune deposits in the skin and renal involvement. SARS‐CoV spike protein immunohistochemical staining was negative. IgAV with skin and renal involvement is a potential reaction to COVID‐19 vaccination.
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Affiliation(s)
- Marc E Grossman
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Gerald Appel
- Department of Internal Medicine, Columbia University Medical Center, New York, New York, USA
| | - Alicia J Little
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Christine J Ko
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Pathology, Yale University School of Medicine, New Haven, Connecticut, USA
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Ball-Burack MR, Kosowsky JM. A Case of Leukocytoclastic Vasculitis Following SARS-COV-2 Vaccination. J Emerg Med 2021; 63:e62-e65. [PMID: 35690533 PMCID: PMC8536729 DOI: 10.1016/j.jemermed.2021.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/27/2021] [Accepted: 10/12/2021] [Indexed: 11/29/2022]
Abstract
Background Although vaccination against coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been proven generally safe, rare but potentially serious adverse reactions do occur. Leukocytoclastic vasculitis (LCV) is a small-vessel vasculitis that has been associated with other immunizations, but, to our knowledge, has not been previously reported in association with vaccines directed against SARS-CoV-2. Case Report We report the case of a 22-year-old man with no known past medical history who presented to the Emergency Department with 2 days of migratory arthritis in his ankles and palpable purpura on his bilateral lower extremities, occurring 10 days after receiving the Johnson & Johnson SARS-CoV-2 vaccine. The patient's clinical presentation was suggestive of leukocytoclastic vasculitis, and this diagnosis was confirmed on skin biopsy. Why Should an Emergency Physician Be Aware of This? Recognition of vasculitides is important for timely treatment and prevention of complications. In a patient presenting with palpable purpura after immunization against SARS-CoV-2, LCV should be promptly considered and worked up by the Emergency Physician, though management is most often entirely outpatient and the clinical course is typically mild and self-resolving.
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Affiliation(s)
- Maya R Ball-Burack
- Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | - Joshua M Kosowsky
- Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
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