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Abstract: SA-PO590

Cerebral Venous Sinus Thrombosis in a Child With IgA Vasculitis and COVID-19 Infection

Session Information

  • Pediatric Nephrology - II
    November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1800 Pediatric Nephrology

Authors

  • Erspamer, Kayla J., Oregon Health & Science University Doernbecher Children's Hospital, Portland, Oregon, United States
  • Canty, Ethan Abraham, Oregon Health & Science University Doernbecher Children's Hospital, Portland, Oregon, United States
  • Baz, Bronwyn, Oregon Health & Science University Doernbecher Children's Hospital, Portland, Oregon, United States
  • Bauer, Abbie R., Oregon Health & Science University Doernbecher Children's Hospital, Portland, Oregon, United States
Introduction

IgA vasculitis (IgAV) is a common diagnosis in children and includes purpura, and/or petechiae (without thrombocytopenia or coagulopathy) with at least one of the following: abdominal pain, joint pain, AKI, hematuria, proteinuria, or evidence of IgA deposition. Many cases are preceded by upper respiratory tract infections, including COVID-19. The incidence of cerebral venous sinus thrombosis (CVST) in the pediatric population is low (0.6/100,000 per year). We present a case of a 5 year old boy with IgA vasculitis and COVID-19 infection found to have CVST.

Case Description

A previously healthy 5 year old boy transferred to our institution with two weeks of intermittent, severe abdominal pain in the setting of COVID-19 infection with new-onset hematochezia, hypertension, and tachycardia. Abdominal ultrasound, abdominal x-ray, chest x-ray, ANA, C3, C4, ANCA, creatinine, electrolytes, and coagulation factors were normal. Urinalysis was significant for hematuria and a urine protein-to-creatinine ratio (UPC) of 2.02 mg/mg. Purpuric and petechial rash appeared the day after admission. UPC trended up to 4.82 mg/mg and a renal biopsy confirmed the diagnosis of IgA nephropathy. Patient was treated with 30mg/kg/day Solu-Medrol for three days and discharged home on 2mg/kg/day prednisolone daily. He was readmitted two days later with severe left frontal headache. UPC was worse at 5.98 mg/mg and mycophenolic mofetil (MMF) was initiated. Imaging revealed an occlusive thrombus of the left transverse sinus with nonocclusive thrombi in the distal portion of the left lateral sinus and posterior superior sagittal sinus. He started 21mg Lovenox twice daily and had minimal residual thrombosis after three months. His UPC peaked at 20.73 mg/mg and eventually normalized with high-dose steroids, Enalapril, and MMF.

Discussion

This is the first case, to our knowledge, of CVST in a patient with IgAV associated with COVID-19 infection. Multiple case reports of IgA vasculitis associated with COVID-19 infection have been published in the past two years, and this case may support a more careful approach when it comes to screening for pro-coagulation risk factors.