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De Novo IgA Vasculitis Post-Transplant — ESENeph MCQ

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HardTransplantationDe Novo IgA Vasculitis Post-TransplantESENeph

A kidney transplant recipient 6 months post-transplant presents with leukocytoclastic vasculitis and palpable purpura affecting the lower limbs. Biopsy of a skin lesion shows IgA deposits. He has microscopic haematuria and mild proteinuria. His native kidney disease was NOT IgA nephropathy. What is the most likely diagnosis?

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Correct answer: E — De novo IgA vasculitis (Henoch-Schönlein purpura) post-transplant

De novo IgA vasculitis can develop post-transplant, presenting with palpable purpura, arthralgia, abdominal pain, and renal involvement (IgA nephropathy in the allograft). Since his native disease was not IgAN, this is de novo rather than recurrent. The immunosuppressed state may paradoxically predispose to certain immune-mediated conditions. Management follows IgAV nephritis guidelines (supportive care, consider glucocorticoids if severe renal involvement).

Reference: KDIGO 2025 – IgAN/IgAV Guideline; Case reports in transplant literature