|LETTER TO EDITOR
|Year : 2022 | Volume
| Issue : 2 | Page : 206-207
New-onset henoch–Schonlein purpura after COVID-19 vaccination
Rija Mathew Roy, Anna Mani, Joseph John, Thomas Antony, Lydia Jacob
Department of General Medicine, Believers Church Medical College Hospital, Thiruvalla, Kerala, India
|Date of Submission||29-Sep-2021|
|Date of Acceptance||27-Nov-2021|
|Date of Web Publication||05-Apr-2022|
Dr. Rija Mathew Roy
Believers Church Medical College,St Thomas Nagar, Kuttapuzha, Thiruvalla - 689 103, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Roy RM, Mani A, John J, Antony T, Jacob L. New-onset henoch–Schonlein purpura after COVID-19 vaccination. Indian J Rheumatol 2022;17:206-7
A 60-year-old female patient presented with a history of diffuse purpuric lesions [Figure 1] in the lower limbs for 2 days duration. She received the first dose of Covishield vaccine (a nonreplicating adenovirus vector vaccine), 8 days before the onset of rashes. Following the vaccination, she had low-grade fever and local pain at the vaccination site, which resolved in 2 days. The patient also complained of pain in knee joints, itching over the rashes, and diffuse abdominal discomfort. There was no history of upper respiratory tract infections, diarrhea, or blood in the stool. She was on telmisartan 20 mg for hypertension and L-thyroxine 100 mcg for hypothyroidism. On examination, she had palpable purpuric lesions on the lower limbs, buttocks, and abdomen. Examination of the abdomen did not reveal any mass or tenderness. Examination of the other systems was normal. Complete blood count was normal, with normal platelet count. Erythrocyte sedimentation rate was 17 mm in the 1st h and c-reactive protein was 13.9 mg/L. Renal and liver functions tests were also normal. The urine routine showed no proteinuria, but microscopy showed 55–60 pus cells/hpf and 1–2 red blood cells/hpf. Urine culture was not sent, as the patient did not have any urinary symptoms or fever. Antihepatitis C virus and hepatitis B surface antigen were nonreactive. Antistreptolysin O titer was checked as Henoch–Schönlein purpura (HSP) can occur after streptococcal infections, and it was not raised. The patient was put on colchicine 0.5 mg BD and pantoprazole. Colchicine was added, as there were case reports of colchicine use for recurrent and chronic cutaneous lesions of HSP and even for acute HSP. Rashes started fading within 24 h and subsided in another 1 week. Skin biopsy taken from the rash showed evidence of immune complex vasculitis with immunoglobulin M (IgM), C3, and fibrinogen deposits in the vessel wall. The patient was completely asymptomatic on follow-up after 2 weeks with normal urine analysis and serum creatinine.
HSP is an immunoglobulin A (Ig A)-mediated small vessel vasculitis usually found in small children and occasionally in adults. It is usually triggered by streptococcal infections and viral infections such as parvovirus and influenza virus. It has also been reported after influenza vaccine, measles vaccine and typhoid, cholera, and yellow fever vaccinations. Certain drugs and some malignancies have also been associated with HSP. The patient had arthralgia, abdominal pain, palpable purpura with normal platelet count, and abnormal urinary sediments. Direct immunofluorescence of the skin biopsy did not show IgA deposits, but showed IgM, C3, and fibrinogen suggestive of immune complex vasculitis. IgA deposits are likely to be detected, when skin biopsy is taken soon after the onset of rashes. IgA vasculitis with nephritis has been reported after COVID infection in a 78-year-old patient. HSP has also been reported after Pfizer-mRNA vaccine in a 40-year-old female. Reactivation of IgA vasculitis has also been reported after covid vaccination. Asymmetrical cutaneous vasculitis following Covaxin (inactivated viral vaccine by Bharat Biotech) has also been reported.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Jithpratuck W, Elshenawy Y, Saleh H, Youngberg G, Chi DS, Krishnaswamy G. The clinical implications of adult-onset henoch-schonelin purpura. Clin Mol Allergy 2011;9:9.
Suso AS, Mon C, Oñate Alonso I, Galindo Romo K, Juarez RC, Ramírez CL, et al
. IgA vasculitis with nephritis (Henoch-Schönlein Purpura) in a COVID-19 patient. Kidney Int Rep 2020;5:2074-8.
Bostan E, Gulseren D, Gokoz O. New-onset leukocytoclastic vasculitis after COVID-19 vaccine. Int J Dermatol 2021;60:1305-6.
Obeid M, Fenwick C, Pantaleo G. Reactivation of IgA vasculitis after COVID-19 vaccination. Lancet Rheumatol 2021;3:e617.
Kharkar V, Vishwanath T, Mahajan S, Joshi R, Gole P. Asymmetrical cutaneous vasculitis following COVID-19 vaccination with unusual eosinophil preponderance. Clin Exp Dermatol 2021;46:1596-7.