IgA Vasculitis With Cryoglobulin-Like Deposits in Kidney Following COVID-19 Infection

ABSTRACT

Introduction: Infection-related IgA glomerulonephritis with large paramesangial immune deposits appearing like intraluminal cryo deposits have occasionally been described in literature temporally associated with Staphylococcus infection. COVID-19 associated glomerular disease is classically known to manifest as collapsing glomerulopathy, although other types have been reported. Case Description We present a case of a 76-year old Hispanic female with a history of type 2 diabetes, hypertension and a 2-month old history of COVID-19 pneumonia who recently presented with acute kidney injury, dark urine, shortness of breath and leg edema. 2 weeks prior, she had presented with a history of purpuric rash. Urinalysis had shown hematuria and proteinuria, and a skin biopsy showed IgA vasculitis. Blood culture for Staphylococcus was negative. A kidney biopsy now showed IgA glomerulonephritis with focal crescents along with intraluminal pseudothrombi (cryo-plugs) positive for IgA on immunofluorescence. Electron microscopy showed intraluminal occlusive electron-dense deposits. Serum cryoglobulin was negative. The patient was treated with steroids and oral cyclophosphamide, and she responded significantly to treatment. Discussion(s) Our case shows a unique glomerular manifestation of COVID-19 infection in the form of IgA vasculitis with intraluminal cryo-like features, not previously described in literature.