P1335 - Not Just for Kids: A Case of Adult-Onset IgA Vasculitis

William Ghaul, DO, Reema Vaze, MD, Anastasia Shnitser, MD, Hina Sheik, MD
Lehigh Valley Health Network, Allentown, PA

Introduction: IgA Vasculitis is a small-vessel vasculitis mediated by IgA-immune complex deposition. The classic triad of symptoms includes pruritic rash, abdominal pain, and renal damage. Around 90% of cases are observed in children. Treatment involves mainly supportive care. However, if diagnosed in adulthood, the course is more complex. Management of these patients involves immunomodulatory regimens given multi-organ involvement.

Case Description/Methods: A 57-year-old male with multiple prior abdominal surgeries presented with several days of abdominal pain and bloody diarrhea. Physical exam was notable for a diffusely tender abdomen and a palpable, purpuric rash on his lower extremities. Admission lab work revealed a leukocytosis of 26, elevated CRP of 190, and AKI on CKD3b with Cr 1.86 (baseline Cr 1.1). A comprehensive stool test was negative. CTA of the abdomen revealed no active bleeding. Surgery was consulted and recommended no acute surgical intervention. MR enterography ordered by GI showed long segment thickening of the small bowel suggestive of enteritis. Dermatology performed a skin biopsy. Results of the biopsy were ultimately consistent with leukocytoclastic vasculitis with IgA deposition. Oral steroids were initiated. His abdominal pain, bloody diarrhea, and renal function improved. He was discharged with an oral steroid taper and outpatient rheumatology follow-up.

Discussion: Adult-onset IgA vasculitis has been reported in up to 14.3 cases per million patients. Diagnostic criteria include palpable purpura of the lower limbs, abdominal pain, IgA deposition on biopsy, joint pain, and/or renal involvement. The etiology remains unknown but various infections due to MRSA, H. pylori, HIV, or Hepatitis B have been proposed as causes. Although the skin is the most commonly involved site, GI involvement occurs in about 48% of cases. Diffuse abdominal pain typically occurs 1 week after the onset of rash. Endoscopy and colonoscopy are used to establish a diagnosis in these patients. Treatment options include NSAIDs, colchicine, or oral glucocorticoids depending on severity. Malignancies, including lung cancer and multiple myeloma, have been associated with adult-onset IgA vasculitis and work-up should be initiated upon admission.



Disclosures:


William Ghaul, DO, Reema Vaze, MD, Anastasia Shnitser, MD, Hina Sheik, MD. P1335 - Not Just for Kids: A Case of Adult-Onset IgA Vasculitis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.