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Lapides R, Crespo-Quezada J, Thomas T, Carmona Pires F, Chera G. IgA Vasculitis Followed by IgA Nephropathy Without an Identifiable Trigger: The Same Disease or a Spectrum of Related Conditions? Cureus 2023; 15:e45639. [PMID: 37868543 PMCID: PMC10589066 DOI: 10.7759/cureus.45639] [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] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
IgA vasculitis and IgA nephropathy are characterized by IgA deposition in blood vessels and glomerular mesangium, respectively. The former is far more common in the pediatric population, while the latter presents more often in adulthood. A consensus regarding whether these two conditions are manifestations of the same disease that occurs on a spectrum has not yet been reached, and, to our knowledge, no clinical trials to address this question have been conducted. Here, we describe a 27-year-old patient who presented to the emergency department multiple times before being diagnosed with IgA vasculitis with no identifiable trigger and soon after developed IgA nephropathy. This case highlights the importance of ruling out these conditions, especially IgA vasculitis, in adults presenting with a petechial rash, but also the need for studies that investigate whether and how these conditions are related so that patients can be appropriately diagnosed and treated as efficiently as possible.
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Affiliation(s)
- Rebecca Lapides
- Department of Internal Medicine, Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, USA
- Department of Medical Education, Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, USA
| | - Juan Crespo-Quezada
- Department of Internal Medicine, Connecticut Institute for Communities, Danbury, USA
| | - Teena Thomas
- Department of Internal Medicine, Danbury Hospital, Danbury, USA
| | | | - Gagandeep Chera
- Department of Internal Medicine, Connecticut Institute for Communities, Danbury, USA
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Salem Y, Alam Z, Shalabi MM, Hosler GA, Acharya S. IgA Vasculitis Associated With COVID-19. Cureus 2023; 15:e38725. [PMID: 37292558 PMCID: PMC10246862 DOI: 10.7759/cureus.38725] [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] [Accepted: 05/07/2023] [Indexed: 06/10/2023] Open
Abstract
IgA vasculitis, also known as Henoch-Schonlein Purpura (HSP), is an inflammatory disorder of small blood vessels that can present with palpable purpura, arthralgias, abdominal pain, and kidney disease. It is most commonly found in pediatric patients after an inciting infection but has been seen across all ages and associated with certain drugs and vaccines. COVID-19 has been associated with various cutaneous manifestations, but HSP is a rarely reported one. We present a case of a 21-year-old female presenting with a petechial rash found to be seronegative IgA vasculitis presenting concurrently with dyspnea secondary to COVID-19. She was initially seen by an outside practitioner, tested negative for COVID, and was prescribed a course of oral prednisone. Shortly thereafter, she visited the ED for worsening shortness of breath and tested positive for COVID-19, for which she received Paxlovid. Biopsy after a visit to a dermatologist confirmed intramural IgA deposition on immunofluorescence, and she was tapered off prednisone and started on azathioprine.
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Affiliation(s)
- Yousef Salem
- Department of Dermatology, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Zaryab Alam
- Department of Dermatology, Texas A&M College of Medicine, Bryan, USA
| | - Mojahed M Shalabi
- Department of Internal Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, USA
| | - Gregory A Hosler
- Department of Dermatology, University of Texas Southwestern Medical School, Dallas, USA
| | - Sampada Acharya
- Department of Rheumatology, Baylor Scott & White All Saints Medical Center, Fort Worth, USA
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Liu Y, Wen M, He Q, Dang X, Feng S, Liu T, Ding X, Li X, He X. Lipid metabolism contribute to the pathogenesis of IgA Vasculitis. Diagn Pathol 2022; 17:28. [PMID: 35148801 PMCID: PMC8840790 DOI: 10.1186/s13000-021-01185-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 12/03/2021] [Indexed: 12/04/2022] Open
Abstract
Background and objectives The underlying mechanism of IgA vasculitis (IgAV) and IgA vasculitis with nephritis (IgAVN) remains unclear. Therefore, there are no accurate diagnostic methods. Lipid metabolism is related to many immune related diseases, so this study set out to explore the relationship of lipids and IgAV and IgAVN. Methods Fifty-eighth patients with IgAV and 28 healthy controls were recruited, which were divided into six separate pools to investigate the alterations of serum lipids according to the clinical characteristics: healthy controls group (HCs) and IgAV group (IgAVs), IgAVN group (IgAV-N) and IgAV without nephritis group (IgAV-C), initial IgAV group (IgAV0) and IgAV in treatment with glucocorticoids group (IgAV1). Results 31 identified lipid ions significantly changed in IgAVs with p < 0.05, variable importance of the projection (VIP) > 1 and fold change (FC) > 1.5. All these 31 lipid ions belong to 6 classes: triacylglycerols (TG), phosphatidylethanolamine (PE), phosphatidylcholine (PC), phosphatidylserine, ceramide, and lysophosphatidylcholine. TG (16:0/18:1/22:6) +NH4 over 888875609.05, PC (32:1) +H over 905307459.90 and PE (21:4)-H less than 32236196.59 increased the risk of IgAV significantly (OR>1). PC (38:6) +H was significantly decreased (p < 0.05, VIP>1 and FC>1.5) in IgAVN. PC (38:6) less than 4469726623 conferred greater risks of IgAV (OR=45.833, 95%CI: 6.689~341.070). Conclusion We suggest that lipid metabolism may affect the pathogenesis of IgAV via cardiovascular disease, insulin resistance, cell apoptosis, and inflammation. The increase of TG(16:0/18:1/22:6) + NH4, and PC(32:1) + H as well as PE (21:4)-H allow a good prediction of IgAV. PE-to-PC conversion may participate in the damage of kidney in IgAV. PC (38:6) + H may be a potential biomarker for IgAVN. Supplementary Information The online version contains supplementary material available at 10.1186/s13000-021-01185-1.
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Affiliation(s)
- Ying Liu
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Min Wen
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.,Institute of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China.,Laboratory of Pediatric Nephrology, Institute of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qingnan He
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.,Institute of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China.,Laboratory of Pediatric Nephrology, Institute of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiqiang Dang
- Institute of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China.,Laboratory of Pediatric Nephrology, Institute of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shipin Feng
- Department of Pediatric Nephrology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Taohua Liu
- Department of Pediatrics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xuewei Ding
- Institute of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China.,Laboratory of Pediatric Nephrology, Institute of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoyan Li
- Institute of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China.,Laboratory of Pediatric Nephrology, Institute of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiaojie He
- Institute of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China. .,Laboratory of Pediatric Nephrology, Institute of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China.
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Fohle E, Montgomery S, Murat J, Ness R, Lo TS. An Unusual Timing of Amoxicillin-Induced IgA Vasculitis in an Elderly Patient. Cureus 2021; 13:e15757. [PMID: 34290934 PMCID: PMC8289393 DOI: 10.7759/cureus.15757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2021] [Indexed: 11/05/2022] Open
Abstract
Immunoglobulin A vasculitis is a small vessel vasculitis which is usually common in the pediatric group. It is rare in adult population but more severe than in children. Proposed triggers include infections, malignancy and medications. For most part, the association is made when immunoglobulin A vasculitis develops within two weeks after starting the implicated medication. A 66-year-old male who was treated with amoxicillin/clavulanate for presumed right fourth toe infection but returned to the emergency department 48 hours later with palpable purpura of lower limbs, arthralgia with swollen hands and colicky abdominal pain with nausea. Abdominal computed tomography (CT) scan showed mildly dilated small bowel. Skin biopsies showed leukocytoclastic vasculitis with IgA deposit on immunofluorescence. The patient was treated with a short course of steroid and the rash was significantly reduced during subsequent follow-up. Although amoxicillin/clavulanate is widely prescribed, clinicians need to be aware of this risk and immediately stop it if signs of drug-induced vasculitis develop.
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Affiliation(s)
- Emmanuel Fohle
- Internal Medicine, University of North Dakota, Fargo, USA
| | - Sean Montgomery
- Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, USA
| | - Joseph Murat
- Internal Medicine, Veterans Affairs Medical Center, Fargo, USA
| | - Rachel Ness
- Dermatology, Fargo Center for Dermatology, Fargo, USA
| | - Tze Shien Lo
- Infectious Disease, Veterans Affairs Medical Center, Fargo, USA
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