IgA Vasculitis With Nephritis Following Controlled Ovarian Stimulation and Oocyte Donation

A woman in her 20s developed IgA vasculitis with nephritis (IgAVN), which started four days after oocyte donation (for in-vitro fertilisation (IVF) and transfer to another recipient). Prior to oocyte retrieval, the patient received a course of controlled ovarian stimulation (COS) with menotrophin, ganirelix acetate and choriogonadotropin alfa. Four days after COS, she developed a painful purpuric rash alongside knee pain and swelling. Prednisolone was started for presumed IgA vasculitis. Soon after, she developed de novo mononeuritis multiplex and renal dysfunction characterised by haematoproteinuria and nephrotic syndrome. A kidney biopsy confirmed the diagnosis of IgAVN. Symptoms improved over time; however, there remained questions about the possible trigger. The induced sex hormone changes associated with COS may have had an immunomodulatory effect, leading to disease development.