Skip to main content
Top
Published in: BMC Nephrology 1/2022

Open Access 01-12-2022 | IgA Vasculitis | Case report

A case of vasculitis triggered by infective endocarditis in a patient undergoing maintenance hemodialysis: a case report

Authors: Hanui Park, Miji Lee, Jin Seon Jeong

Published in: BMC Nephrology | Issue 1/2022

Login to get access

Abstract

Background

Immunoglobulin A vasculitis (IgA vasculitis) is one of the most common forms of vasculitis in children. It rarely occurs in adults. It is a systemic vasculitis with IgA deposition and is characterized by the classical tetrad of purpura, arthritis/arthralgia, gastrointestinal and renal involvement. Certain types of infections, and pharmacological agents have been reported to be associated with IgA vasculitis. Here, we describe a case of IgA vasculitis triggered by infective endocarditis in a patient undergoing maintenance hemodialysis.

Case presentation

A 70-year-old man undergoing hemodialysis was admitted because of skin purpura, abdominal pain, diarrhea, and lower back pain. We suspected him as IgA vasculitis based on the clinical features and skin biopsy findings. Transesophageal echocardiography revealed infective endocarditis, which predisposed him to IgA vasculitis. He was treated with antibiotics and low-dose corticosteroids, which led to resolution of vasculitis.

Conclusions

This is the first case of IgA vasculitis triggered by infective endocarditis in a patient undergoing hemodialysis. Patients undergoing hemodialysis are at a high risk of infection because of immune dysfunction and frequent venipuncture. The incidence of infective endocarditis associated with IgA vasculitis is very low, but it has been repeatedly reported. Therefore, it is necessary to consider infective endocarditis in patients with clinical features that indicate IgA vasculitis.
Literature
1.
go back to reference Piram M, Mahr A. Epidemiology of immunoglobulin a vasculitis (Henoch-Schönlein): current state of knowledge. Curr Opin Rheumatol. 2013;25(2):171–8.CrossRef Piram M, Mahr A. Epidemiology of immunoglobulin a vasculitis (Henoch-Schönlein): current state of knowledge. Curr Opin Rheumatol. 2013;25(2):171–8.CrossRef
2.
go back to reference Du L, Wang P, Liu C, Li S, Yue S, Yang Y. Multisystemic manifestations of IgA vasculitis. Clin Rheumatol. 2021;40(1):43–52.CrossRef Du L, Wang P, Liu C, Li S, Yue S, Yang Y. Multisystemic manifestations of IgA vasculitis. Clin Rheumatol. 2021;40(1):43–52.CrossRef
3.
go back to reference Audemard-Verger A, Pillebout E, Guillevin L, Thervet E, Terrier B. IgA vasculitis (Henoch-Shönlein purpura) in adults: diagnostic and therapeutic aspects. Autoimmun Rev. 2015;14(7):579–85.CrossRef Audemard-Verger A, Pillebout E, Guillevin L, Thervet E, Terrier B. IgA vasculitis (Henoch-Shönlein purpura) in adults: diagnostic and therapeutic aspects. Autoimmun Rev. 2015;14(7):579–85.CrossRef
4.
go back to reference 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(1):9.CrossRef 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(1):9.CrossRef
5.
go back to reference Esposito C, Fasoli G, Cornacchia F, Foschi A, Mazzullo T, Morando G, et al. Henoch-Schönlein purpura in a chronic hemodialysis patient. J Nephrol. 1999;12(3):197–200.PubMed Esposito C, Fasoli G, Cornacchia F, Foschi A, Mazzullo T, Morando G, et al. Henoch-Schönlein purpura in a chronic hemodialysis patient. J Nephrol. 1999;12(3):197–200.PubMed
6.
go back to reference Yoshino J, Sasamura H, Konishi K, Tsuji M, Suda N, Yoshida T, et al. A case of Henoch-Schönlein purpura in a patient on hemodialysis. Nihon Jinzo Gakkai Shi. 2007;49(1):49–53.PubMed Yoshino J, Sasamura H, Konishi K, Tsuji M, Suda N, Yoshida T, et al. A case of Henoch-Schönlein purpura in a patient on hemodialysis. Nihon Jinzo Gakkai Shi. 2007;49(1):49–53.PubMed
7.
go back to reference Gao JJ, Wei JM, Gao YH, Li S, Na Y. Central venous catheter infection-induced Henoch-Schönlein purpura in a patient on hemodialysis. Ren Fail. 2014;36(7):1145–7.CrossRef Gao JJ, Wei JM, Gao YH, Li S, Na Y. Central venous catheter infection-induced Henoch-Schönlein purpura in a patient on hemodialysis. Ren Fail. 2014;36(7):1145–7.CrossRef
8.
go back to reference Lamikanra O, Obanor S, Tuneev K, Ponnusamy V, Seneviratne C, Yoon TS, et al. Presentation of Henoch Schonlein Purpura in an elderly man with end stage renal disease. Chest. 2019;156(4):A1300–1.CrossRef Lamikanra O, Obanor S, Tuneev K, Ponnusamy V, Seneviratne C, Yoon TS, et al. Presentation of Henoch Schonlein Purpura in an elderly man with end stage renal disease. Chest. 2019;156(4):A1300–1.CrossRef
9.
go back to reference Chitralli DK, Churchill BM, Patri P, Puttegowda D. IgA Vasculitis in a patient on Dialysis. Asian journal of research. Nephrology. 2020:17–23. Chitralli DK, Churchill BM, Patri P, Puttegowda D. IgA Vasculitis in a patient on Dialysis. Asian journal of research. Nephrology. 2020:17–23.
10.
go back to reference Montoliu J, Miró JM, Campistol JM, Trilla A, Mensa J, Torras A, et al. Henoch-Schönlein Purpura complicating staphylococcal endocarditis in a heroin addict. Am J Nephrol. 1987;7(2):137–9.CrossRef Montoliu J, Miró JM, Campistol JM, Trilla A, Mensa J, Torras A, et al. Henoch-Schönlein Purpura complicating staphylococcal endocarditis in a heroin addict. Am J Nephrol. 1987;7(2):137–9.CrossRef
11.
go back to reference Hočevar A, Rotar Z, Jurčić V, Pižem J, Čučnik S, Vizjak A, et al. IgA vasculitis in adults: the performance of the EULAR/PRINTO/PRES classification criteria in adults. Arthrit Res Ther. 2016;18(1):58.CrossRef Hočevar A, Rotar Z, Jurčić V, Pižem J, Čučnik S, Vizjak A, et al. IgA vasculitis in adults: the performance of the EULAR/PRINTO/PRES classification criteria in adults. Arthrit Res Ther. 2016;18(1):58.CrossRef
12.
go back to reference Syed-Ahmed M, Narayanan M. Immune dysfunction and risk of infection in chronic kidney disease. Adv Chronic Kidney Dis. 2019;26(1):8–15.CrossRef Syed-Ahmed M, Narayanan M. Immune dysfunction and risk of infection in chronic kidney disease. Adv Chronic Kidney Dis. 2019;26(1):8–15.CrossRef
13.
go back to reference Girndt M, Sester M, Sester U, Kaul H, Köhler H. Defective expression of B7-2 (CD86) on monocytes of dialysis patients correlates to the uremia-associated immune defect. Kidney Int. 2001;59(4):1382–9.CrossRef Girndt M, Sester M, Sester U, Kaul H, Köhler H. Defective expression of B7-2 (CD86) on monocytes of dialysis patients correlates to the uremia-associated immune defect. Kidney Int. 2001;59(4):1382–9.CrossRef
14.
go back to reference Meier P, Golshayan D, Blanc E, Pascual M, Burnier M. Oxidized LDL modulates apoptosis of regulatory T cells in patients with ESRD. J Am Soc Nephrol. 2009;20(6):1368–84.CrossRef Meier P, Golshayan D, Blanc E, Pascual M, Burnier M. Oxidized LDL modulates apoptosis of regulatory T cells in patients with ESRD. J Am Soc Nephrol. 2009;20(6):1368–84.CrossRef
15.
go back to reference Kuroki Y, Tsuchida K, Go I, Aoyama M, Naganuma T, Takemoto Y, et al. A study of innate immunity in patients with end-stage renal disease: special reference to toll-like receptor-2 and-4 expression in peripheral blood monocytes of hemodialysis patients. Int J Mol Med. 2007;19(5):783–90.PubMed Kuroki Y, Tsuchida K, Go I, Aoyama M, Naganuma T, Takemoto Y, et al. A study of innate immunity in patients with end-stage renal disease: special reference to toll-like receptor-2 and-4 expression in peripheral blood monocytes of hemodialysis patients. Int J Mol Med. 2007;19(5):783–90.PubMed
16.
go back to reference Heineke MH, Ballering AV, Jamin A, Ben Mkaddem S, Monteiro RC, Van Egmond M. New insights in the pathogenesis of immunoglobulin a vasculitis (Henoch-Schönlein purpura). Autoimmun Rev. 2017;16(12):1246–53.CrossRef Heineke MH, Ballering AV, Jamin A, Ben Mkaddem S, Monteiro RC, Van Egmond M. New insights in the pathogenesis of immunoglobulin a vasculitis (Henoch-Schönlein purpura). Autoimmun Rev. 2017;16(12):1246–53.CrossRef
17.
go back to reference Berquist JB, Bartels CM. Rare association of Henoch-Schönlein Purpura with recurrent endocarditis. WMJ. 2011;110(1):38.PubMedPubMedCentral Berquist JB, Bartels CM. Rare association of Henoch-Schönlein Purpura with recurrent endocarditis. WMJ. 2011;110(1):38.PubMedPubMedCentral
18.
go back to reference Gadela NV, Drekolias D, Rizkallah A, Jacob J. Infective endocarditis: a rare trigger of immunoglobulin a Vasculitis in an adult. Cureus. 2020;12(8). Gadela NV, Drekolias D, Rizkallah A, Jacob J. Infective endocarditis: a rare trigger of immunoglobulin a Vasculitis in an adult. Cureus. 2020;12(8).
19.
go back to reference Galaria NA, LoPressti NP, Magro CM. Henoch-Schonlein purpura secondary to subacute bacterial endocarditis. CUTIS-NEW YORK. 2002;69(4):269–79. Galaria NA, LoPressti NP, Magro CM. Henoch-Schonlein purpura secondary to subacute bacterial endocarditis. CUTIS-NEW YORK. 2002;69(4):269–79.
20.
go back to reference Wang JX, Perkins S, Totonchy M, Stamey C, Levy LL, Imaeda S, et al. Endocarditis-associated IgA vasculitis: two subtle presentations of endocarditis caused by Candida parapsilosis and Cardiobacterium hominis. JAAD case reports. 2020;6(3):243–6.CrossRef Wang JX, Perkins S, Totonchy M, Stamey C, Levy LL, Imaeda S, et al. Endocarditis-associated IgA vasculitis: two subtle presentations of endocarditis caused by Candida parapsilosis and Cardiobacterium hominis. JAAD case reports. 2020;6(3):243–6.CrossRef
21.
go back to reference Cojocariu C, Stanciu C, Ancuta C, Danciu M, Chiriac S, Trifan A. Immunoglobulin a vasculitis complicated with Clostridium difficile infection: a rare case report and brief review of the literature. J Gastrointestin Liver Dis. 2016;25(2):235–8.CrossRef Cojocariu C, Stanciu C, Ancuta C, Danciu M, Chiriac S, Trifan A. Immunoglobulin a vasculitis complicated with Clostridium difficile infection: a rare case report and brief review of the literature. J Gastrointestin Liver Dis. 2016;25(2):235–8.CrossRef
Metadata
Title
A case of vasculitis triggered by infective endocarditis in a patient undergoing maintenance hemodialysis: a case report
Authors
Hanui Park
Miji Lee
Jin Seon Jeong
Publication date
01-12-2022

Other articles of this Issue 1/2022

BMC Nephrology 1/2022 Go to the issue