Skip to main content

Advertisement

SpringerLink
Log in

A rare twist: COVID-19 infection masquerading as IgA vasculitis in a hemophilia a patient

  • CASE BASED REVIEW
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Hemophilia A and B are one of the most common hereditary bleeding disorders. Patients are predisposed to bleeding spontaneously or after minor trauma in different areas such as the skin, gastrointestinal, or joints. COVID-19 infection has been associated with various clinical manifestations and complications including rarely triggering IgA vasculitis. We report a 23-year-old man who was previously diagnosed with severe hereditary hemophilia A. He presented to our hospital with classic symptoms of IgA vasculitis, complaining of petechiae and purpura in his limbs, fatigue, body aches, poor oral intake, abdominal pain, and watery non-bloody diarrhea. He did not present with respiratory symptoms or fever typical of COVID-19 infection. Abnormal blood tests were mildly elevated C-reactive protein, elevated d-dimers, and low Factor VIII activity. Extensive immunological tests were negative. CT abdomen with contrast was unremarkable. A skin biopsy strongly indicated IgA vasculitis. COVID-19 test came back positive. The patient was managed symptomatically and with glucocorticosteroids which significantly improved his symptoms. The available literature on clinical features, laboratory tests, and management of COVID-19-associated IgA vasculitis is discussed. However, there is no case reported on the associations between hemophilia, COVID-19 infection, and IgA vasculitis. This is the first case of atypical COVID-19 infection masquerading as de novo IgA vasculitis in an adult patient with underlying hemophilia. Our case contributes to the growing body of literature about hemophilia being a possible predisposing factor that a COVID-19 virus relies on to amplify immune dysregulation resulting in IgA vasculitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Centers for Disease Control and Prevention: what is hemophilia? Available at: https://www.cdc.gov/ncbddd/hemophilia/facts.html. Accessed 24 Jan 2024

  2. Mehta P, Reddivari AKR. Hemophilia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK551607/. Accessed 24 Jan 2024

  3. Teng WJ, Kung CH, Cheng MM, Tsai JR, Chang CY (2023) Intramural hematoma of gastrointestinal tract in people with hemophilia A and B. J Clin Med 12(9). https://doi.org/10.3390/jcm12093093

  4. Suvvari TK, Kutikuppala LVS, Tsagkaris C, Corriero AC, Kandi V (2021) Post-COVID-19 complications: multisystemic approach. J Med Virol 93(12):6451–6455. https://doi.org/10.1002/jmv.27222

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Alkindi F, Al Nokhatha S, Alseiari K, Alnaqbi KA (2022) Reactive hip arthritis and avascular necrosis after severe COVID-19 infection: a case report and comprehensive review of literature. EMJ 7(1):48–55. https://doi.org/10.33590/emj/21-00261

    Article  Google Scholar 

  6. Davis HE, McCorkell L, Vogel JM, Topol EJ (2023) Long COVID: major findings, mechanisms and recommendations. Nat Rev Microbiol 21(3):133–146. https://doi.org/10.1038/s41579-022-00846-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Lovato A, de Filippis C (2020) Clinical presentation of COVID-19: a systematic review focusing on upper airway symptoms. Ear Nose Throat J 99(9):569–576. https://doi.org/10.1177/0145561320920762

    Article  PubMed  Google Scholar 

  8. Messova A, Pivina L, Muzdubayeva Z, Sanbayev D, Urazalina Z, Adams A (2022) COVID-19 and new onset IgA vasculitis: a systematic review of case reports. J Emerg Nurs 48(4):348–365. https://doi.org/10.1016/j.jen.2022.05.002

    Article  PubMed  PubMed Central  Google Scholar 

  9. Audemard-Verger A, Pillebout E, Guillevin L, Thervet E, Terrier B (2015) IgA vasculitis (Henoch-Shonlein purpura) in adults: diagnostic and therapeutic aspects. Autoimmun Rev 14(7):579–585. https://doi.org/10.1016/j.autrev.2015.02.003

    Article  CAS  PubMed  Google Scholar 

  10. Jelusic M, Sestan M (2021) IgA vasculitis or Henoch-Schonlein purpura: genetics and beyond. Pediatr Nephrol 36(8):2149–2153. https://doi.org/10.1007/s00467-021-04987-z

    Article  PubMed  Google Scholar 

  11. Onate I, Ortiz M, Suso A, Mon C, Galindo K, Lentisco C, Camacho R, Sanchez M, Oliet A, Ortega O, Herrero JC, Cortes JA, Pascual A (2022) IgA vasculitis with nephritis (Henoch-Schonlein purpura) after COVID-19: a case series and review of the literature. Nefrologia (Engl Ed) 42(4):481–489. https://doi.org/10.1016/j.nefroe.2022.11.003

    Article  PubMed  Google Scholar 

  12. Shetty VM, Subramaniam K, Rao R (2017) Utility of immunofluorescence in dermatology. Indian Dermatol Online J 8(1):1–8. https://doi.org/10.4103/2229-5178.198774

    Article  PubMed  PubMed Central  Google Scholar 

  13. Galvan Casas C, Catala A, Carretero Hernandez G, Rodriguez-Jimenez P, Fernandez-Nieto D, Rodriguez-Villa Lario A, Navarro Fernandez I, Ruiz-Villaverde R, Falkenhain-Lopez D, Llamas Velasco M, Garcia-Gavin J, Baniandres O, Gonzalez-Cruz C, Morillas-Lahuerta V, Cubiro X, Figueras Nart I, Selda-Enriquez G, Romani J, Fusta-Novell X, Melian-Olivera A, Roncero Riesco M, Burgos-Blasco P, Sola Ortigosa J, Feito Rodriguez M, Garcia-Doval I (2020) Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol 183(1):71–77. https://doi.org/10.1111/bjd.19163

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Cheung KS, Hung IFN, Chan PPY, Lung KC, Tso E, Liu R, Ng YY, Chu MY, Chung TWH, Tam AR, Yip CCY, Leung KH, Fung AY, Zhang RR, Lin Y, Cheng HM, Zhang AJX, To KKW, Chan KH, Yuen KY, Leung WK (2020) Gastrointestinal manifestations of SARS-CoV-2 infection and virus load in fecal samples from a Hong Kong cohort: systematic review and meta-analysis. Gastroenterology 159(1):81–95. https://doi.org/10.1053/j.gastro.2020.03.065

    Article  CAS  PubMed  Google Scholar 

  15. Batu ED, Sener S, Ozen S (2022) COVID-19 associated pediatric vasculitis: a systematic review and detailed analysis of the pathogenesis. Semin Arthritis Rheum 55:152047. https://doi.org/10.1016/j.semarthrit.2022.152047

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Wong K, Farooq Alam Shah MU, Khurshid M, Ullah I, Tahir MJ, Yousaf Z (2022) COVID-19 associated vasculitis: a systematic review of case reports and case series. Ann Med Surg (Lond) 74:103249. https://doi.org/10.1016/j.amsu.2022.103249

    Article  PubMed  Google Scholar 

  17. Abu-Zaid MH, Salah S, Lotfy HM, El Gaafary M, Abdulhady H, Tabra SAA, Salah H, Farag Y, Eissa M, Maher SE, Radwan A, El-Shanawany AT, Medhat BM, El Mikkawy D, Mosad Mosa D, El Deriny G, Mortada M, Osman NS, Fouad NA, Elkaraly NE, Mohamed SS, Hassan WA, Amer YA, Nasef SI, El Miedany Y (2021) Consensus evidence-based recommendations for treat-to-target management of immunoglobulin A vasculitis. Ther Adv Musculoskelet Dis 13:1759720X211059610. https://doi.org/10.1177/1759720X211059610

  18. Feng K, Liu C, Zhang K, Hao J (2023) Successful treatment of Henoch-Schonlein purpura-associated hematochezia in a child with hemophilia A: a case report. BMC Pediatr 23(1):98. https://doi.org/10.1186/s12887-023-03874-w

    Article  PubMed  PubMed Central  Google Scholar 

  19. Sharathkumar A, Wendt L, Ortman C, Srinivasan R, Chute CG, Chrischilles E, Takemoto CM, National CCCC (2024) COVID-19 outcomes in persons with hemophilia: results from a US-based national COVID-19 surveillance registry. J Thromb Haemost 22(1):61–75. https://doi.org/10.1016/j.jtha.2023.04.040

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to express their gratitude to Dr. Maryam Darwish (consultant hematologist at Sheikh Khalifa Specialty Hospital in Ras Al Khaimah, UAE) and Dr. Mozah Almarshoodi (consultant hematologist at Tawam Hospital, UAE) for their review and feedback on the manuscript.

Funding

None declared.

Author information

Authors and Affiliations

  1. Division of Rheumatology, Tawam Hospital, P. O. Box 15258, Al Ain, United Arab Emirates

    Khalid A. Alnaqbi

  2. Internal Medicine Department, College of Medicine & Health Sciences, UAE University, P. O. Box 1551, Al Ain, United Arab Emirates

    Khalid A. Alnaqbi

  3. Academic Affairs, Tawam Hospital, Al Ain, United Arab Emirates

    Nasser Abunamous

  4. Department of Anatomical Pathology, PureLab, Abu Dhabi, United Arab Emirates

    Tausif Saleem

Authors
  1. Khalid A. Alnaqbi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nasser Abunamous
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tausif Saleem
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study conception and design: KAA.

Followed the clinical case, literature review: KAA, NA.

Diagnosis, data collection, draft manuscript preparation: KAA, NA, TS.

All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Khalid A. Alnaqbi.

Ethics declarations

Ethical approval and written informed consents

The case report was approved by SEHA Research Ethics Committee (approval # HREC SEHA-IRB-526). Informed written consent was taken from the patient.

Disclosures

None.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alnaqbi, K.A., Abunamous, N. & Saleem, T. A rare twist: COVID-19 infection masquerading as IgA vasculitis in a hemophilia a patient. Clin Rheumatol 43, 1393–1399 (2024). https://doi.org/10.1007/s10067-024-06902-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-024-06902-x

Keywords

Search

Navigation