Abstract
A 76 year-old female came to our observation one week after the vaccination with ChAdOx1 nCoV-19 AZD1222 for the onset of purpuric rash on her gluteal and legs regions associated with coxalgia and episodes of macrohaematuria. Henoch-Schönlein purpura (HSP) was diagnosed on the basis of the revised criteria developed by the European League Against Rheumatism, the Paediatric Rheumatology International Trials Organization, and the Paediatric Rheumatology European Society (EULAR/PRINTO/PRES). HSP is a common IgA-mediated small vessel vasculitis, typical of childhood, that affects several systems and is characterized by a tetrad of dermatological, abdominal, joint, and renal manifestations. The Etiology of HSP is not completely understood, but it was observed following upper respiratory tract infections, medications, vaccinations, and malignancies. HSP has previously been reported following immunization with various vaccines, mostly within 12 weeks post, suggesting a possible correlation. To our knowledge, this is the first report of the possible association between COVID-19 ChAdOx1 nCoV-19 AZD1222 and the onset of HSP in a previously healthy woman. No similar cases were reported amongst 23.848 participants in the ChAdOx1 nCoV-19 AZD1222 trial.
Highlights
Growing apprehension about the risks of vaccination have been associated with the current global health situation
Obeid et coll. reported a case of reactivation of IgA vasculitis occurring after COVID-19 vaccination and suggested a possible link between the reactivation of pre-existing IgA vasculitis observed after vaccination and the increase in anti-SARS-CoV-2 spike IgA
Three cases of haematuria and IgA nephropathy flares following the second dose of mRNA COVID-19 vaccines have been reported in subjects with biopsy-proven IgA nephropathy, one patient following the BNT162b2 (BioNTech-Pfizer) vaccine, two of these after the mRNA-1273 vaccine [29]
Summary
Growing apprehension about the risks of vaccination have been associated with the current global health situation. In the safety evaluation of a vaccine, it is difficult to take into account interindividual factors, such as the genetic predisposition to immune hyperstimulation and autoimmunity. Evidence of palpable purpura in the absence of thrombocytopaenia (1) Acute onset diffuse abdominal pain (2) Acute onset arthralgia or arthritis (3) Renal involvement in the form of proteinuria or haematuria (4) Histopathological evidence of leucocytoclastic vasculitis or proliferative glomerulonephritis with predominant IgA deposits. The etiology of HSP is not completely understood and seems to be associated with genetic and environmental factors, infections, medications, vaccinations or malignancies [10]. The aim of this report is to highlight the possible association between COVID-19 ChAdOx1 nCoV-19 AZD1222 and first onset of HSP in a previously healthy adult. There were no cases reported amongst 23.848 participants in the ChAdOx1 nCoV-19 AZD1222 safety and immunogenicity trial [12]
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