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Suszek D, Grzywa-Celińska A, Emeryk-Maksymiuk J, Krusiński A, Redestowicz K, Siwiec J. IgA vasculitis after COVID-19: a case-based review. Rheumatol Int 2024; 44:1353-1357. [PMID: 38739223 PMCID: PMC11178596 DOI: 10.1007/s00296-024-05606-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/26/2024] [Indexed: 05/14/2024]
Abstract
IgA-associated vasculitis (IgAV) known as Henoch - Schönlein purpura (HSP) disease is an inflammatory disorder of small blood vessels. It's the most common type of systemic vasculitis in children which can be associated with the inflammatory process following infections. IgA vasculitis is a rare and poorly understood systemic vasculitis in adults. Coronavirus disease 2019 (COVID-19) has been associated with HSP in both adults and children. A 58-year-old woman was diagnosed with HSP, fulfilling the clinical criteria: palpable purpura, arthritis, hematuria. The disclosure of the HSP disease was preceded by a infection of the respiratory tract. COVID-19 infection was confirmed via the presence of IgM and IgG antibodies. This case indicates the possible role of SARS-CoV-2 in the development of HSP. The clinical course of IgAV in adults appears to be different from pediatric IgAV, especially due to higher risk of renal complications. Symptoms of the disease quickly resolved with low-dose of steroids.
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Affiliation(s)
- Dorota Suszek
- Department of Rheumatology and Connective Tissue Diseases, Medical University, Lublin, Poland.
| | - Anna Grzywa-Celińska
- Department of Pneumonology, Oncology and Allergology, Medical University, Lublin, Poland
| | | | - Adam Krusiński
- Department of Pneumonology, Oncology and Allergology, Medical University, Lublin, Poland
| | - Katarzyna Redestowicz
- Department of Pneumonology, Oncology and Allergology, Medical University, Lublin, Poland
| | - Jan Siwiec
- Department of Pneumonology, Oncology and Allergology, Medical University, Lublin, Poland
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Alnaqbi KA, Abunamous N, Saleem T. A rare twist: COVID-19 infection masquerading as IgA vasculitis in a hemophilia a patient. Clin Rheumatol 2024; 43:1393-1399. [PMID: 38353792 DOI: 10.1007/s10067-024-06902-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/25/2024] [Accepted: 02/01/2024] [Indexed: 03/19/2024]
Abstract
Hemophilia A and B are one of the most common hereditary bleeding disorders. Patients are predisposed to bleeding spontaneously or after minor trauma in different areas such as the skin, gastrointestinal, or joints. COVID-19 infection has been associated with various clinical manifestations and complications including rarely triggering IgA vasculitis. We report a 23-year-old man who was previously diagnosed with severe hereditary hemophilia A. He presented to our hospital with classic symptoms of IgA vasculitis, complaining of petechiae and purpura in his limbs, fatigue, body aches, poor oral intake, abdominal pain, and watery non-bloody diarrhea. He did not present with respiratory symptoms or fever typical of COVID-19 infection. Abnormal blood tests were mildly elevated C-reactive protein, elevated d-dimers, and low Factor VIII activity. Extensive immunological tests were negative. CT abdomen with contrast was unremarkable. A skin biopsy strongly indicated IgA vasculitis. COVID-19 test came back positive. The patient was managed symptomatically and with glucocorticosteroids which significantly improved his symptoms. The available literature on clinical features, laboratory tests, and management of COVID-19-associated IgA vasculitis is discussed. However, there is no case reported on the associations between hemophilia, COVID-19 infection, and IgA vasculitis. This is the first case of atypical COVID-19 infection masquerading as de novo IgA vasculitis in an adult patient with underlying hemophilia. Our case contributes to the growing body of literature about hemophilia being a possible predisposing factor that a COVID-19 virus relies on to amplify immune dysregulation resulting in IgA vasculitis.
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Affiliation(s)
- Khalid A Alnaqbi
- Division of Rheumatology, Tawam Hospital, P. O. Box 15258, Al Ain, United Arab Emirates.
- Internal Medicine Department, College of Medicine & Health Sciences, UAE University, P. O. Box 1551, Al Ain, United Arab Emirates.
| | | | - Tausif Saleem
- Department of Anatomical Pathology, PureLab, Abu Dhabi, United Arab Emirates
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3
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Park SH, Jo SM, Kim SW, Lee JM, Baek HS. An Investigation of the Relationship between Henoch-Schönlein Purpura and Viral Infection in Korea Using the Health Insurance Database. J Clin Med 2024; 13:1290. [PMID: 38592700 PMCID: PMC10931917 DOI: 10.3390/jcm13051290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: This study investigated the epidemiology and viral connections of Henoch-Schönlein purpura (HSP) using information from the Korea Disease Control and Prevention Agency and the Health Insurance Review and Assessment database. (2) Method: Between 2016 and 2019, a total of 25,443 patients with HSP were identified, with 51.3% of patients under the age of 20 years and the highest incidence in March. (3) Results: The autoregressive integrated moving average model and Granger causality test were used to analyze the association between the virus positivity detection rate and HSP incidence. (4) Conclusions: The incidence of HSP was associated with rotavirus, bocavirus, parainfluenza virus, and respiratory syncytial virus in individuals under 20 years of age, whereas adenovirus, respiratory syncytial virus, and norovirus were associated with individuals above that age.
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Affiliation(s)
- So Hyeon Park
- Department of Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea; (S.H.P.); (S.M.J.)
| | - Su Min Jo
- Department of Medicine, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea; (S.H.P.); (S.M.J.)
| | - Sang Won Kim
- Medical Research Center, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea;
| | - Jae Min Lee
- Department of Pediatrics, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
| | - Hee Sun Baek
- Department of Pediatrics, College of Medicine, Yeungnam University, Daegu 42415, Republic of Korea
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Greistorfer T, Jud P. Clinical characteristics of COVID-19 associated vasculopathic diseases. Thromb J 2023; 21:61. [PMID: 37231476 DOI: 10.1186/s12959-023-00504-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023] Open
Abstract
Coronavirus disease 19 (COVID-19) has shown to be an infectious disease affecting not only of the respiratory system, but also cardiovascular system leading to different COVID-19-associated vasculopathies. Venous and arterial thromboembolic events have been frequently described among hospitalized patients with COVID-19 and inflammatory vasculopathic changes have also been observed. Several of the reported COVID-19 associated vasculopathies exhibit differences on epidemiology, clinical characteristics and outcome compared to non-COVID-19 types. This review focuses on the epidemiology, clinical, diagnostic and therapeutic characteristics as well as outcome data of COVID-19 associated thromboembolic events and inflammatory vasculopathies, elaborating similarities and differences with non-COVID-19 cohorts.
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Affiliation(s)
- Thiemo Greistorfer
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria
| | - Philipp Jud
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria.
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Ahlers CG, Wang B, Howell DN, Choksi V. Extensive Palpable Purpura Preceding Renal Dysfunction in Immunoglobulin A Vasculitis due to Coronavirus-19 Infection. Am J Med 2023:S0002-9343(23)00249-8. [PMID: 37068573 PMCID: PMC10105621 DOI: 10.1016/j.amjmed.2023.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/16/2023] [Accepted: 03/22/2023] [Indexed: 04/19/2023]
Affiliation(s)
- Carolyn G Ahlers
- Department of Medicine, Duke University Hospital, 2301 Erwin Road, Durham, North Carolina, 27710, USA.
| | - Bangchen Wang
- Department of Pathology, Duke University Hospital, 2301 Erwin Road, Durham, North Carolina, 27710, USA
| | - David N Howell
- Department of Pathology, Duke University Hospital, 2301 Erwin Road, Durham, North Carolina, 27710, USA
| | - Vinay Choksi
- Department of Medicine, Duke University Hospital, 2301 Erwin Road, Durham, North Carolina, 27710, USA
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Belozerov KE, Avrusin IS, Andaryanova LI, Guseva AM, Shogenova ZS, Belanovich IN, Lobacheva AV, Kornishina TL, Isupova EA, Masalova VV, Kalashnikova OV, Nokhrin AV, Panova TF, Dutova YP, Myshkovskaya SL, Kostyunin KY, Komissarov AB, Chasnyk VG, Bregel LV, Kostik MM. COVID-19 Associated Vasculitis Confirmed by the Tissues RT-PCR: A Case Series Report. Biomedicines 2023; 11:biomedicines11030870. [PMID: 36979849 PMCID: PMC10046188 DOI: 10.3390/biomedicines11030870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/16/2023] Open
Abstract
Background: Several cases of skin and central nervous system vasculopathy associated with COVID-19 in children have been published, but the information is rather limited. Our study aimed to describe these cases of vasculitis associated with COVID-19 in children. Methods: In the retrospective-prospective case series study we included information regarding four children with COVID-19-associated vasculitis. In every case, we had a morphological description and the etiology was confirmed via real-time polymerase chain reaction during a tissue biopsy. Results: The most involved systems were skin (4/4), respiratory (3/4), cardiovascular (2/4), nervous (1/4), eye (1/4), kidney (1/4), and inner year (1/4). All patients had increased inflammatory markers and thrombotic parameters (D-dimer). No patient met the criteria for multisystem inflammatory syndrome in children. Two patients met polyarteritis nodosa criteria, one met Henoch–Schonlein purpura criteria, and one met unclassified vasculitis criteria. All patients were treated with systemic glucocorticosteroids (two-pulse therapy). Non-biologic DMARDs were prescribed in all cases; 1/4 patients (25%) was treated with intravenous immunoglobuline, and 3/4 (75%) were treated with biologics (etanercept, tocilizumab, and adalimumab). Conclusions: Vasculitis associated with COVID-19 could be a life-threatening condition; SARS-CoV-2 might be a new trigger or etiological agent for vasculitis and other immune-mediated diseases. Further research and collection of similar cases are required.
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Affiliation(s)
- Konstantin E. Belozerov
- Hospital Pediatry, Saint Petersburg State Pediatric Medical University, 194100 Saint Petersburg, Russia
| | - Ilia S. Avrusin
- Hospital Pediatry, Saint Petersburg State Pediatric Medical University, 194100 Saint Petersburg, Russia
| | - Lyubov I. Andaryanova
- Hospital Pediatry, Saint Petersburg State Pediatric Medical University, 194100 Saint Petersburg, Russia
| | - Anna M. Guseva
- Hospital Pediatry, Saint Petersburg State Pediatric Medical University, 194100 Saint Petersburg, Russia
| | - Zaira S. Shogenova
- Hospital Pediatry, Saint Petersburg State Pediatric Medical University, 194100 Saint Petersburg, Russia
| | - Irina N. Belanovich
- Hospital Pediatry, Saint Petersburg State Pediatric Medical University, 194100 Saint Petersburg, Russia
| | - Anna V. Lobacheva
- Hospital Pediatry, Saint Petersburg State Pediatric Medical University, 194100 Saint Petersburg, Russia
| | - Tatiana L. Kornishina
- Hospital Pediatry, Saint Petersburg State Pediatric Medical University, 194100 Saint Petersburg, Russia
| | - Eugenia A. Isupova
- Hospital Pediatry, Saint Petersburg State Pediatric Medical University, 194100 Saint Petersburg, Russia
| | - Vera V. Masalova
- Hospital Pediatry, Saint Petersburg State Pediatric Medical University, 194100 Saint Petersburg, Russia
| | - Olga V. Kalashnikova
- Hospital Pediatry, Saint Petersburg State Pediatric Medical University, 194100 Saint Petersburg, Russia
| | - Andrey V. Nokhrin
- Hospital Pediatry, Saint Petersburg State Pediatric Medical University, 194100 Saint Petersburg, Russia
| | - Tatyana F. Panova
- Pediatric Department, Leningrad Regional Children’s Clinical Hospital, 195009 Saint Petersburg, Russia
| | - Yulia P. Dutova
- Pediatric Department, Leningrad Regional Children’s Clinical Hospital, 195009 Saint Petersburg, Russia
| | - Svetlana L. Myshkovskaya
- Pediatric Department, Leningrad Regional Children’s Clinical Hospital, 195009 Saint Petersburg, Russia
| | - Kirill Y. Kostyunin
- Pathology Department, Irkutsk State Medical University, 664003 Irkutsk, Russia
- Irkutsk Regional Diagnostic Centre, Department of Clinical Pathomorpholigy, 664047 Irkutsk, Russia
| | - Andrey B. Komissarov
- Laboratory of Molecular Virology, Smorodintsev Research Institute of Influenza, 197376 Saint Petersburg, Russia
| | - Vyacheslav G. Chasnyk
- Hospital Pediatry, Saint Petersburg State Pediatric Medical University, 194100 Saint Petersburg, Russia
| | - Liudmila V. Bregel
- Department of Pediatrics, Irkutsk State Medical Academy of Postgraduate Education, Branch of Russian Medical Academy of Continuous Professional Education, 664049 Irkutsk, Russia
- Department of Pediatric Cardiology, Irkutsk Regional Children’s Hospital, 664022 Irkutsk, Russia
| | - Mikhail M. Kostik
- Hospital Pediatry, Saint Petersburg State Pediatric Medical University, 194100 Saint Petersburg, Russia
- Correspondence: or
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Viral Infections May Be Associated with Henoch-Schönlein Purpura. J Clin Med 2023; 12:jcm12020697. [PMID: 36675626 PMCID: PMC9862009 DOI: 10.3390/jcm12020697] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 01/17/2023] Open
Abstract
Henoch-Schönlein purpura or IgA vasculitis is the most common type of pediatric vasculitis that may affect adults as well. It is classified as a type of small-vessel vasculitis. It can cause cutaneous and systemic symptoms with a minority of patients developing kidney failure. Little is known about the specific pathophysiology of this disorder, except that it is believed to occur in individuals with abnormally glycosylated IgA1. Serum aberrant IgA1 may form large antigen-antibody complexes which, due to a defective clearance, are able to deposit in the small vessels of the skin, kidney, gut, and joints. A variety of factors, including infectious agents, drugs, and vaccines, have been identified as potential triggers. The majority of cases are preceded by upper respiratory tract infections, and seasonal variations suggest a link with many pathogens. The etiologic agent most frequently associated with IgA vasculitis historically have been group A β-hemolytic streptococcus and common respiratory tract viruses. However, during the current coronavirus pandemic, SARS-CoV-2 infection was identified as a main trigger factor. In addition, IgA vasculitis has been observed following COVID-19 immunization. This review provides insights into the state of the art on the relationship between viral infections, viral vaccines, and Henoch-Schönlein purpura.
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Alpsoy E. Cutaneous vasculitis; An algorithmic approach to diagnosis. Front Med (Lausanne) 2022; 9:1012554. [PMID: 36213632 PMCID: PMC9532537 DOI: 10.3389/fmed.2022.1012554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Vasculitides, characterized by inflammation and damage of blood vessels, encompass a broad spectrum of diseases. They can occur with different pathophysiological mechanisms and have a rich clinical heterogeneity depending on the vessel diameters they affect. Vasculitides may also present with a broad spectrum of severity, ranging from a mild self-limiting to a potentially life-threatening disease. The high prevalence of skin involvement in vasculitis, visible character and, finally, the easy accessibility of the skin for both physical examination and biopsy offers important advantages for prompt disease recognition and diagnosis. Thus, dermatologists are privileged to diagnose the disease earlier and more effectively than any other discipline. As a consequence, a detailed clinical and histopathological evaluation of the skin is one of the most critical steps in diagnosing vasculitis. Besides obtaining a good medical history, laboratory and radiological evaluation methods are used in the diagnosis. In this review, a practical and algorithmic approach is aimed to assist in the diagnosis of vasculitis. However, this approach should not be seen as strict rules. This stepwise algorithmic diagnostic approach for vasculitis was developed by combining the current literature knowledge and the author's experience in this field to provide a rational framework for selecting the most appropriate among various diagnostic approaches.
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Maronese CA, Zelin E, Avallone G, Moltrasio C, Romagnuolo M, Ribero S, Quaglino P, Marzano AV. Cutaneous vasculitis and vasculopathy in the era of COVID-19 pandemic. Front Med (Lausanne) 2022; 9:996288. [PMID: 36082274 PMCID: PMC9445267 DOI: 10.3389/fmed.2022.996288] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Cutaneous vasculitides encompass a heterogeneous group of clinicopathological entities, which may occur as single-organ vasculitis of the skin or present as skin-limited variant of systemic vasculitis (i.e., skin-limited ANCA-associated vasculitis), and are triggered by various factors, including infections, drugs and vaccines. The COVID-19 pandemic has challenged us with a variety of both disease- and vaccine-associated skin manifestations, including vasculitis. Among the latter, cutaneous small-vessel vasculitis, previously known as leukocytoclastic vasculitis, seems to be the most reported in either scenario, i.e., natural infection and vaccination. Vasculopathy without true vasculitic changes on histology develops in but a minority of cases, mostly severe/critical COVID-19 patients, and appears to be the result of endothelial injury due to pauci-immune thromboembolic mechanisms. Herein, we provide an overview of the available literature on COVID-19-associated and anti-SARS-CoV-2-vaccine-associated cutaneous vasculitis. Although evidence is mostly limited to isolated reports, with a proportion of cases lacking histopathological confirmation, ample overlap with pre-pandemic forms is shown.
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Affiliation(s)
- Carlo Alberto Maronese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Enrico Zelin
- Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy
| | - Gianluca Avallone
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Maurizio Romagnuolo
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Simone Ribero
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Pietro Quaglino
- Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- *Correspondence: Angelo Valerio Marzano
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