PMC8675622_01
Clinical manifestations of immunoglobulin A vasculitis. (A) Palpable purpuric rash on the lower extremities 2 weeks after the patient received the first dose of the severe acute respiratory syndrome coronavirus 2 mRNA vaccine (BNT162b2, Pfizer, Inc) and (B) after 2 weeks of oral corticosteroids. Microscopic examination of urinary sediment stained with Sternheimer-Malbin stain revealed glomerular hematuria, characterized by acanthocytes (arrows) inspected under (C) phase-contrast microscopy and (D) dark-field microscopy illumination. Original magnification x400.
toj-21-0083-figure1.jpg
PMC8675622_01_toj-21-0083-figure1.jpg
f1
Six weeks prior to presentation, the patient had developed a skin rash on his lower legs that erupted 2 weeks after he received the first dose of a SARS-CoV-2 mRNA vaccine (BNT162b2 (mRNA), Pfizer, Inc) (Figure 1). Microscopic examination of the urinary sediment revealed acanthocytes (Figure 1).
Kidney biopsy specimen showing pathologic features of immunoglobulin A (IgA) nephropathy. (A) Focal mild mesangial hypercellularity was present (periodic acid Schiff stain, original magnification x400). (B) IgA-dominant granular diffuse global mesangial staining for IgA was present, 3+ on a 0 to 3+ scale (anti-IgA immunofluorescence, original magnification x400).
toj-21-0083-figure2.jpg
PMC8675622_01_toj-21-0083-figure2.jpg
f2
Mild mesangial hypercellularity was present in only 1 of the 16 glomeruli in the light microscopy sample, with no endocapillary hypercellularity, no segmental sclerosis, minimal (approximately 5%) interstitial fibrosis and tubular atrophy, and no crescents or necrosis (Figure 2).
Timeline of case report. Day -4 corresponds to 4 days before the patient received the first dose of vaccine. UA, urinalysis; UPCR, urine protein to creatinine ratio.
toj-21-0083-figure3.jpg
PMC8675622_01_toj-21-0083-figure3.jpg
f3
Figure 3 presents a timeline of the case.