P2703 - IgA Vasculitis Imitating Inflammatory Bowel Disease in a Middle-Aged Man

Kevin Yang, MD, Ali A.. Aijaz, DO, Naren S. Nallapeta, MBBS, Mayada Ismail, MD
University at Buffalo, Buffalo, NY

Introduction: Immune globulin A vasculitis (IGAV) is most commonly seen in the pediatric population, and typical presentation may involve palpable purpura, arthralgia, abdominal pain, and kidney disease. We describe a case of IGAV in a 45-year-old male whose presentation included abdominal pain, hematochezia, and terminal ileitis.

Case Description/Methods: A 45-year-old male with past medical history of hypertension, non-alcoholic fatty liver disease, and diverticulitis presented initially with right lower quadrant abdominal pain and bloody diarrhea. This was the first occurrence of these symptoms, which had been ongoing for 2 days with poor appetite as well. He denied any recent changes in diet, travel or outdoor exposures, sick contacts, fever or chills. On examination he was hemodynamically stable and afebrile. His physical exam was remarkable for a diffusely tender abdomen as well as bright red blood on rectal exam. A faint maculopapular rash on his bilateral lower extremities was noticed later on. The patient underwent CT imaging of the abdomen that demonstrated dramatic long segmental wall thickening of the terminal ileum, suggestive of infectious versus Crohn’s colitis. Blood tests showed a hemoglobin level of 15.5 g/dL with a mild leukocytosis, and stool studies were sent including cultures, ova and parasites, and clostridium difficile testing, which all resulted as negative. He was subsequently started on week-long corticosteroid therapy. The patient ultimately underwent skin biopsy showing perivascular IgA, C3, and fibrin deposition. His hematochezia and abdominal pain sginificantly improved throughout the week and had completely resolved by the end of his corticosteroid treatment. Colonoscopy was performed in the outpatient setting after resolution of symptoms, with biopsies showing a normal terminal ileum and colonic mucosa.

Discussion: IgA vasculitis is particularly rare in the adult population, especially when presenting initially with abdominal pain, hematochezia, and terminal ileitis suggestive of inflammatory bowel disease (IBD). The differential diagnosis at the time of presentation mainly included infectious versus inflammatory colitis. The patient also did not have renal or joint involvement. However, he was noted to have a subtle maculopapular rash of the lower extremities later on. Regardless, there are evidently similarities between IBD and IgA vasculitis, which may have overlapping environmental triggers for immune activation as well.


Disclosures:


Kevin Yang, MD, Ali A.. Aijaz, DO, Naren S. Nallapeta, MBBS, Mayada Ismail, MD. P2703 - IgA Vasculitis Imitating Inflammatory Bowel Disease in a Middle-Aged Man, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.