Gastrointestinal manifestations of IgA vasculitis guiding treatment in an adult patient.

Abstract

IgA vasculitis (IgAV), a small-vessel systemic vasculitis characterised by arthritis, renal involvement and palpable purpura without thrombocytopenia, predominantly affects children and is rare in adults. Immunosuppressive treatment is typically reserved for significant renal involvement or refractory abdominal and joint pain. However, therapeutic targets for gastrointestinal involvement remain poorly defined. A man in his 20s with no medical history presented with weeks of abdominal pain, post-prandial vomiting, purpuric rash, arthralgia and hypertension. Urine studies showed subnephrotic range proteinuria and colonoscopy revealed ileal ulceration. Immunofluorescence of skin, ileal and renal biopsies demonstrated perivascular IgA deposition, confirming IgAV. Although renal involvement did not necessitate treatment, recurrent severe gastrointestinal symptoms and biochemical evidence of liver involvement prompted a 6-week course of oral prednisone following multidisciplinary consultation. His symptoms resolved, with complete normalisation of renal function and liver enzymes.