key: cord-0973026-x9ed42fr
authors: Messova, Assylzhan; Pivina, Lyudmila; Muzdubayeva, Zhanna; Sanbayev, Didar; Urazalina, Zhanar; Adams, Amber
title: COVID-19 and new onset IgA vasculitis: A systematic review of case reports.
date: 2022-05-13
journal: J Emerg Nurs
DOI: 10.1016/j.jen.2022.05.002
sha: da9d52450c3bd9eb365532dc2b84adb16e117110
doc_id: 973026
cord_uid: x9ed42fr

Introduction Immunoglobulin A (IgA) vasculitis is historically more commonly found in children after certain viral infections such as Epstein-Barr, varicella virus, and parvovirus B19. COVID-19 has not been formally established in literature as a trigger for IgA vasculitis. However, a main pathogenetic mechanism of COVID-19 is vascular damage, which makes it likely vasculitis associated with COVID-19 (i.e., COVID-19 mediated IgA vasculitis) could be biologically plausible, with serious implications, especially for adults. The purpose of this review is to assist emergency nurses in gaining knowledge on the pathophysiology, symptoms, and treatment of COVID-19 mediated IgA vasculitis. Methods A systematic search for case reports of COVID-19 associated IgA vasculitis was conducted in the PubMed and Scopus electronic databases. The search terms used were COVID-19, coronavirus 2019, SARS COVID-19, and IgA vasculitis, case reports. The following were the inclusion criteria: publication dates between December 1, 2019, and April 1, 2021; full text article, clinical case studies and letters to the editor available electronically in English. The following were exclusion criteria: a summary of reports and newspaper publications. Results Only 13 clinical cases met the inclusion criteria. The median age of patients described in the case reports were 38.1 years. Three of them were children less than 5 years old. Twelve patients were male. In seven of thirteen cases of IgA vasculitis, renal involvement was found. Discussion The analysis of published clinical cases showed that COVD-19 associated IgA vasculitis affected mostly adults; and was characterized by a more severe course due to renal involvement. COVID-19 may be a possible trigger for IgA-related disorders. More research is needed to better understand the relationship between IgA vasculitis in relation to COVID-19.

Introduction 47 6 retrospective study by French vasculitis group, as well as prospective study by Pillebot et al., 126 showed there is no significant difference between combined treatment of glucocorticoids with 127 immune suppressors (cyclophosphamide) and glucocorticoid treatment alone as it relates to 128 patient outcome and mortality [25] . Recent studies demonstrated the efficiency of Rituximab, 129 a monoclonal antibody medication, in the treatment of adult-onset IgA vasculitis [26] . 130 Colchicine and dapsone have also been reported to be effective for treating chronic IgA 131 vasculitis. However, there are still no randomized controlled trials to determine the optimal 132 therapeutic dose and duration of treatment [27] . Finally, plasma exchange in combination with 133 steroids has been associated with good outcomes in adults with IgA vasculitis. 134 Relapses typically occur in 20-30% of individuals diagnosed with adult-onset IgA vasculitis. 135 The predictor of relapse was persistent purpura, severe leucocytoclastic vasculitis, abdominal 136 pain, haematuria and adult onset of the disease [28] . 138 We searched PubMed and Scopus databases for articles including case reports published 139 between December 1, 2019, and February 1, 2021, using the following keywords: "COVID-140 19", "coronavirus 2019", "SARS COVID-2", and "IgA vasculitis". Clinical case studies and 141 letters to the editor that were written in English and accessible in full text were included.

Summary reports and newspaper publications were excluded. For inclusion, we independently 143 reviewed the titles and abstracts of retrieved citations, and any inconsistencies were resolved 144 by consensus. The PRISMA checklist for writing a systematic review of case reports was used.

The quality of clinical cases were evaluated by Equator network's CARE checklist. In total, 680 146 full-text publications were checked, with reference lists manually scanned for additional studies There were only 13 cases that met the requirements for inclusion. In the presented clinical cases, 150 5 out of 13 were found in children. IgAV is more common in children, while COVID-19 151 associated IgAV is more common in adults (8 cases from 13). Our data is consistent with the 152 results of other study [29] . The analysis of clinical cases showed that COVID-19 associated Case reports included for synthesis (n = 13)

Screening Included J o u r n a l P r e -p r o o f 

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