Severe Colitis Secondary to IgA Vasculitis in Elderly 1578

• Published in: The American journal of gastroenterology Vol. 113; no. Supplement; pp. S908 - S909
• Main Authors: Zivari, Kaveh, Kantrowitz, Michael G., Niknam, Negar, Mayer, Ira E., Rahmani, Rabin
• Format: Journal Article
• Language: English
• Published: New York Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.10.2018
• Subjects: Abdomen; Edema; Gastroenterology; Hemorrhage; Inflammatory bowel disease; Intestinal obstruction; Pain; Purpura; Steroids
• ISSN: 0002-9270; 1572-0241
• DOI: 10.14309/00000434-201810001-01578

Introduction: IgA Vasculitis, previously known as Henoch-Schönlein purpura, is an immune complex vasculitis affecting small vessels with dominant IgA deposits. It is the most common in children with only 10% of cases occurring in the adult population. It is typically more severe in the adult population. it is more common in males. It is self-limiting and characterized by palpable purpura, arthralgia, abdominal pain, and renal disease. Majority of the patient will experience the rash and the arthralgia, while only half the patient will have some abdominal pain which could be from the gastrointestinal hemorrhage, bowel ischemia and necrosis, intussusception, and bowel perforation. Case Presentation: 57-year-old Chinese woman presented with abdominal pain and melena mixed with mucose. The patient had upper respiratory tract infection a week prior and shortly after had developed a non-blanching petechial lesions that had spread from her lower extremity to her gluteal and later to her upper extremity. She also had new joint pain in her hands. At the time of presentation, her rash was improving. Patient also had Acute kidney injury as well. Her exam revealed tender abdomen. CT imaging showed severe Pancolitis. The patient was started on IV fluid and antibiotics. Once infection sources of colitis were ruled out Steroid was started. Renal biopsy confirmed IGA Vasculitis. After the start of steroid patients colitis and renal function started to improve. Patients rash also began to fade as well. Discussion: IgA vasculitis can cause severe Gastrointestinal symptoms typically within eight days of the appearance of the rash. There have been some case reports of GI manifestations at much longer intervals. Gastrointestinal pain associated with IgA vasculitis is caused by submucosal hemorrhage and edema. Purpuric lesions may be seen on endoscopy, commonly in the descending duodenum, stomach, and colon. Edema and hemorrhage can act as a pathologic lead point, contributing to the development of intussusception which is the most common gastrointestinal complication of IgA Vasculitis.