key: cord-0936690-ca2wbt95 authors: Hashizume, Hideo; Ajima, Sayaka; Ishikawa, Yuto title: Immunoglobulin A vasculitis post‐severe acute respiratory syndrome coronavirus 2 vaccination and review of reported cases date: 2022-02-28 journal: J Dermatol DOI: 10.1111/1346-8138.16326 sha: dc8d1bdca96f4c481cbc601e2e152e718e18b955 doc_id: 936690 cord_uid: ca2wbt95 Immunoglobulin (Ig)A vasculitis/nephropathy is a systemic immune complex‐mediated vasculitis. Although severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) vaccination is widely recommended in individuals without specific allergy to the vaccine components, it is arguable whether vaccination is advisable for patients with IgA vasculitis or for predisposed individuals. We and others have presented cases of IgA vasculitis occurring after SARS‐CoV‐2 vaccination. In total, these 19 cases, including ours, involved predominantly female patients, and half of them were suffering from de novo vasculitis onset. The most frequent manifestation was gross hematuria (89.5%) while skin lesions were relatively infrequent, occurring in only five cases (26.3%), of which three (15.8%) were confirmed to be IgA vasculitis. Taken together, these cases suggest that SARS‐CoV‐2 vaccination might be a trigger for development/deterioration of IgA vasculitis/nephropathy. Abdominal pain gradually alleviated; however, hematuria persisted for several months. Thereafter, the patient gave written informed consent to the publication of her case details. Eighteen previously documented cases of IgA nephropathy/vasculitis occurring post-SARS-CoV-2 vaccination are summarized in Table 1 , [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] along with the present case. Sufferers were predominantly female adults (female/male ratio, 3.75; mean age, 42.8 ± 17.7 years). Although IgA vasculitis is common in children, the age distribution observed might reflect the fact that this vaccination was predominantly given to adults. The order of frequency in which vaccines induced vasculitis was Moderna (10 cases), Pfizer (eight cases), and Oxford-AstraZeneca (one case). Twelve cases (63%) occurred after the second injection. The interval between injection and onset ranged 1-30 days (mean, 4.7 ± 7.2 days) but the most frequent interval was 1-2 days. Approximately half of the cases (47.4%) presented with de novo onset, and the remainder were exacerbated cases of pre-existing disease. The most frequent manifestation was gross hematuria (17/19 [89.5%]) while skin lesions were observed in only five cases (26.3%), among which three (15.8%) were proven to be IgA vasculitis. In nine of the 19 cases (47.4%), the disease resolved spontaneously in 2-7 days, while 10 cases (52.6%) required intensive treatments including angiotensin-converting enzyme inhibitor (one case) 6 and diphenyl sulfone (this case); steroid pulse therapy (two cases); 14 oral corticosteroid administration (four cases); 6,7,13 renal transplantation (one case) 5 and hemodialysis (one case) 5 . In our case, the clinical and laboratory features at the first visit fulfilled all the EULAR/PRINTO/PRES criteria for IgA vasculitis. 1 Upon interview, the patient disclosed that she had been suffering intermittent abdominal pains for more than 5 years, which might represent a prodrome of IgA vasculitis. SARS-CoV-2 infection reportedly exacerbates IgA vasculitis/nephropathy; 11 however, the pros and cons of SARS-CoV-2 vaccination in patients with IgA vasculitis/nephropathy or predisposed individuals remain controversial. [3] [4] [5] 7, 9, 10, [12] [13] [14] Despite the uncertainty of pre-existing disease in this case, the narrow time window between vaccination and disease onset implied a close connection, which prompted us to survey similar cases in the literature. This work was supported in part by grants from the Ministry of Education, Culture, Sports, Science, and Technology (24390276) and the Health and Labor Sciences Research Grants from the Ministry of Health, Labor, and Welfare of Japan. None declared. https://orcid.org/0000-0002-5809-0040 EULAR/PRINTO/PRES criteria for Henoch-Schönlein purpura,childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: final classification criteria Drug-induced IgA vasculitis in children and adults: revisiting drug causality using a dual pharmacovigilance-based approach SARS-CoV-2 vaccination and anaphylaxis: recommendations of the French Allergy Community and the Montpellier World Health Organization Collaborating Center A case of gross hematuria and IgA nephropathy flare-up following SARS-CoV-2 vaccination Gross hematuria following SARS-CoV-2 vaccination in patients with IgA nephropathy Letter regarding: "a case of gross hematuria and IgA nephropathy flare-up following SARS-CoV-2 vaccination Reactivation of IgA vasculitis after COVID-19 vaccination Gross hematuria following vaccination for severe acute respiratory syndrome coronavirus 2 in 2 patients with IgA nephropathy Histologic correlates of gross hematuria following Moderna COVID-19 vaccine in patients with IgA nephropathy Henoch-Schönlein purpura presenting post COVID-19 vaccination The pathogenesis of COVID-19-induced IgA nephropathy and IgA vasculitis: a systematic review A case of leukocytoclastic vasculitis after vaccination with a SARS-CoV2-vaccine -a case report IgA vasculitis in adult patient following vaccination by ChadOx1 nCoV-19 Is COVID-19 vaccination unmasking glomerulonephritis? Immunoglobulin A vasculitis post-severe acute respiratory syndrome coronavirus 2 vaccination and review of reported cases