COVID-19 Like Findings in a Fatal Case of Idiopathic Desquamative Interstitial Pneumonia Associated With IgA Glomerulonephritis in a 13-Month-Old Child

Adult-Onset IgA Vasculitis Associated With Pulmonary-Renal Syndrome Following COVID-19 Infection: A Case Report and Literature Review

Immunoglobulin A (IgA) vasculitis, also known as Henoch-Schönlein purpura (HSP), is an immune complex-mediated inflammation of small blood vessels that leads to tissue destruction with or without organ damage. We described a case of a 41-year-old otherwise healthy female who presented with an ascending rash distributed on both lower extremities and arthralgia. Blood testing revealed high blood urea nitrogen (BUN), creatinine, and inflammatory markers, as well as a negative autoimmune panel. Urinalysis revealed proteinuria and hematuria. A kidney biopsy was performed, which revealed abnormalities. She was started on intravenous (IV) methylprednisolone pulse therapy. Suddenly, she complained of epistaxis and became desaturated. Computed tomography revealed bilateral pleural effusion, and she was transferred to the ICU. Bronchoalveolar lavage was performed and was consistent with an increasing bloodier return. Plasma exchange was performed. The rash and clinical symptoms improved dramatically. This study reports a case of IgA vasculitis based on The European Alliance of Associations for Rheumatology/Pediatric Rheumatology International Trials Organization/Pediatric Rheumatology European Society (EULAR/PRINTO/PRES) criteria associated with pulmonary-renal syndrome following a case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

The pathogenesis of COVID-19-induced IgA nephropathy and IgA vasculitis: A systematic review

OBJECTIVE

IgA nephropathy (IgAN) and IgA vasculitis (IgAV) are part of a similar clinical spectrum. Both clinical conditions occur with the coronavirus disease 2019 (COVID-19). This review aims to recognize the novel association of IgAN and IgAV with COVID-19 and describe its underlying pathogenesis.

METHODS

We conducted a systematic literature search and data extraction from PubMed, Cochrane, ScienceDirect, and Google Scholar following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

Our search identified 13 cases reporting IgAV and IgAN associated with COVID-19 infection and 4 cases of IgAN following COVID-19 vaccination. The mean, mode, and median ages of patients were 23.8, 4, and 8 years, respectively. Most cases associated with COVID-19 infection were reported in males (77%). Rash and purpura (85%) were the most common clinical features, followed by gastrointestinal symptoms (62%). In symptomatic cases, skin or renal biopsy and immunofluorescence confirmed the diagnosis of IgAN or IgAV. Most patients were treated with steroids and reported recovery or improvement; however, death was reported in two patients.

CONCLUSION

There is a paucity of scientific evidence on the pathogenesis of the association of IgAN and IgAV with COVID-19, which thus needs further study. Current research suggests the role of IgA-mediated immune response, evidenced by early seroconversion to IgA in COVID-19 patients and the role of IgA in immune hyperactivation as the predominant mediator of the disease process. Clinicians, especially nephrologists and paediatricians, need to recognize this association, as this disease is usually self-limited and can lead to complete recovery if prompt diagnosis and treatment are provided.

Clinical significance of cellular immunity function and inflammatory factors assays in alveolar lavage fluid for severe COVID-19 pneumonia

In this study, we aimed to investigate the changes of lymphocyte subsets (CD3⁺ , CD4⁺ , CD8⁺ ) and inflammatory factors (interleukin-6 [IL-6], hypersensitive C-reactive protein [HS-CRP], and procalcitonin [PCT]) of alveolar lavage fluid in patients with severe corona virus-2019 (COVID-19) pneumonia and their clinical impact on the assessment of disease severity and prognosis. Twenty-four patients with severe COVID-19 pneumonia were admitted to the intensive care unit (ICU) of the Ezhou Central Hospital from February 1 to March 22, 2020. According to the 28-day prognosis, they were assigned to a death group and a survival group. On the 3rd day of ICU admission, peripheral blood and alveolar lavage fluid were collected for examination of lymphocyte subsets and inflammatory factors by flow cytometry and immunoturbidimetry, respectively. The CD3⁺ , CD4⁺ , and CD8⁺ cell counts in alveolar lavage fluid and serum were significantly higher in the survival group than those of the death group (p < .05). The levels of IL-6, HS-CRP, and PCT in the alveolar lavage fluid and serum of the death group were statistically higher than those of the survival group (p < .05); The CD3⁺ , CD4⁺ cell count, and IL-6 level were negatively correlated with Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II scores, respectively (p < .05). The CD4⁺ cell and SOFA score have a regression relationship for the prognosis of COVID-19 severe patients. The CD3⁺ , CD4⁺ , CD8⁺ cells, and IL-6 levels are valuable in determining the prognosis of severe COVID-19 pneumonia and are strongly correlated with the severity of the disease; the CD4⁺ cell is an independent risk factor affecting the prognosis of COVID-19 pneumonia.