Table 1 Patient demographics and clinical information

Clinical presentation

  Age, yr/race/sex

76/Korean/Male

  Medical history

Leukocytoclastic vasculitis, 10 years ago

  Vaccine name

BNT162b2 (BioNTech-Pfizer)

  Date of vaccination

    First dose

April, 24, 2021

    Second dose

May, 14, 2021

  Timing of purpura occurrence after the second dose

10 days

  Timing of nephrotic syndrome occurrence after the second dose

45 days

  Other associated symptoms

Abdominal pain, diarrhea

Laboratory datas (after the second dose of vaccine)

  On day 10

Serum creatinine, mg/dl

1.06

Serum albumin, g/dl

3.8

UPCR, mg/mg

NA

RBC, cells/μl

NA

  On day 45

Serum creatinine, mg/dl

1.42

Serum albumin, g/dl

2.7

UPCR, mg/mg

9.01

RBC, cells/μl

20–29

  On day 60

Serum creatinine, mg/dl

1.04

Serum albumin, g/dl

3.0

UPCR, mg/mg

8.07

RBC, cells/μl

20–29

  On day 120

Serum creatinine, mg/dl

1.03

Serum albumin, g/dl

3.5

UPCR, mg/mg

1.97

RBC, cells/μl

10–19

Histopathology

  Glomeruli

27 glomeruli; 4 (15%) global sclerosis, 10 (37%) cellular or fibrocellular crescents, 2 (7%) segmental sclerosis

  Tubules and interstitium

Focal severe tubule atrophy and fibrosis in interstitium (< 10% of cortical area)

  Vessels

Mild arteriolosclerosis

  Immunofluorescence

Dominant IgA staining

  Electron microscopy

Moderate amounts of mesangial deposits; normal thickness of GBM; focal moderate effacement of epithelial cell foot processes

Treatment

I.V. Methylprednisolone 250 mg for 3 days followed by oral prednisolone; olmesartan 40 mg