Nephrotic syndrome caused by IgA vasculitis flare up following COVID-19 vaccination

作者：Taro Horino, Y Osakabe, Masayuki Ishihara, Kimiko Nakajima, Yoshio Terada · 发表于：QJM · 年份：2023 · DOI：10.1093/qjmed/hcad040 · 被引用次数：4 · 研究领域：Renal Diseases and Glomerulopathies、Vasculitis and related conditions、Heparin-Induced Thrombocytopenia and Thrombosis

The coronavirus disease 2019 (COVID-19) mRNA vaccine can cause flare ups of glomerulonephritis, especially in patients with IgA vasculitis. The reporting of relevant cases can help us examine and understand the mechanisms of disease onset following COVID-19 vaccination, and thus, implement measures to prevent the recurrence or exacerbation of such diseases. A 64-year-old female patient presented to our nephrology clinic with haematuria, proteinuria and palpable purpura on both lower legs. She had been treated for immunoglobulin A (IgA) vasculitis for 10 years from the age of 7 and had been in long-term remission without treatment thereafter. One month prior to her visit, she had experienced fever and gross haematuria the day after she received the fourth dose of the BNT162b2 mRNA coronavirus disease 2019 (COVID-19) vaccine. Several days later, the fever and gross haematuria subsided, but purpura appeared on both lower legs. The patient visited a local dermatologist who referred her to our clinic. Physical examination showed pitting oedema and palpable purpura on both lower legs. Serum creatinine was 0.84 mg/dl on admission, which increased to 1.05 mg/dl by hospital Day 7 and was 1.65 mg/dl on hospital Day 12. Urinalysis revealed 20 red blood cells per high power field and granulocytic casts in the urine sediment. Urine protein excretion was 6.7 g/gCr. A renal biopsy specimen collected on hospital Day 7 showed mild mesangial cell and mesangial matrix proliferation, endocapilla...