Two cases of adult-onset de novo immunoglobulin A vasculitis with nephritis: Post-Covishield (ChAdOx1 nCoV-19; Oxford–Astra Zeneca) vaccination

Abstract

With the ongoing worldwide COVID-19 vaccination programs, new-onset glomerular disease and relapse of the preexisting glomerular disease have been reported after COVID-19 vaccines administration. These incidences are overall very rare and had just temporal association with vaccination. It is, therefore, the causal link with the COVID 19 vaccine is not firmly established. In this case-based review, we present two cases, who presented with purpuric rashes and joint pain between 2 and 3 weeks of 2nd dose of Covishield (ChAdOx1 nCoV-19; Oxford–Astra Zeneca) vaccination. Routine evaluation in both these cases revealed significant proteinuria and microscopic hematuria. The diagnosis of immunoglobulin A (IgA) vasculitis with nephritis was established with renal biopsy suggestive of IgA nephropathy and skin biopsy findings of leukocytoclastic vasculitis. Both these cases had severe renal involvement and responded to oral glucocorticoids after 8–16 weeks of treatment. Close observation and careful monitoring of these cases are required to determine the incidence of de novo or recurrence of glomerular disease postvaccination, the need for immunosuppressive therapy, response to aggressive treatment, and long-term clinical outcomes.

Keywords

• covid-19 vaccine
• glomerulonephritis
• glucocorticoid
• immuanoglobulin a vasculitis
• purpura