Development of IgA vasculitis with severe glomerulonephritis after COVID-19 vaccination: a case report and literature review

We present the case of a 67-year-old Japanese woman who developed IgAV with purpura on her extremities and trunk in the evening of the day that she received the second dose of the Pfizer-BioNTech COVID-19 vaccine. She subsequently presented with acute kidney injury and nephrotic syndrome, and a kidney biopsy performed 14  days after the second vaccination showed diffuse mesangial and endocapillary glomerulonephritis with necrotizing crescent formation, accompanied by IgA deposition. One steroid pulse plus four administrations of a monthly intravenous cyclophosphamide injection were applied, followed by oral azathio prine during oral steroid tapering. Her response to this treatment was unsatisfactory and intractable for some time. Eventually, her renal function improved and nephrotic syndrome was resolved, while microscopic hematuria and proteinuria at ~ 1 g/gCr remained at 6 months post-vaccination. Unli ke the previous milder renal-involved IgAV cases following COVID-19 vaccination, our patient’s case presented severe glomerulonephritis and took a long time to recover despite intensive initial immunosuppressive treatment.
Source: CEN Case Reports - Category: Urology & Nephrology Source Type: research