2525 A Case of IgA Vasculitis Diagnosed With Small Bowel Biopsy

INTRODUCTION: Immunoglobulin A (IgA) vasculitis is an immune-mediated condition that primarily targets small vessels. Presentation may vary- colicky abdominal pain, palpable purpura, acute arthritis, or nephritis. Adult annual incidence is 0.8-1.8/100,000. In adults, abdominal pain is rarely the presenting symptom. We report a case that presented with abdominal pain and was diagnosed with IgA vasculitis via duodenal biopsy. CASE DESCRIPTION/METHODS: A 60 year old male presented with acute onset severe periumbilical pain and watery diarrhea for several days. Pain was associated with vomiting and worsened after meals. Physical examination revealed marked periumbilical and right lower quadrant tenderness. Other review of systems and physical exam findings were unremarkable. Laboratory tests were remarkable for mild leukocytosis with neutrophilic predominance and elevated C-reactive protein. CT scan of the abdomen/pelvis showed significant patchy small bowel thickening with surrounding inflammatory changes. Small bowel enteroscopy showed edematous, purpuric and friable mucosa in the duodenum and proximal jejunum with stigmata of recent bleeding. Biopsies were obtained. Immunostaining for IgA was positive in the lamina propria, suspicious for small bowel IgA vasculitis. Shortly after that, he developed palpable purpura on upper and lower extremities. Punch skin biopsy confirmed IgA vasculitis. He was started on taper of systemic steroids, which lead to the resolution of skin and abdominal vasculitis within a few days. Currently, patient is in remission on rituximab maintenance therapy. DISCUSSION: In cases of abdominal involvement, IgA vasculitis has a predilection for small intestine. The classic endoscopic findings are diffuse mucosal reddening with hemorrhagic erosions and hematoma-like protrusions. Treatment is dependent on severity of vasculitis activity. For moderate to severe disease, systemic corticosteroids and analgesics are the mainstay of treatment. The diagnosis of IgA vasculitis is challenging, especially if abdominal pain precedes other manifestations. This case highlights the diagnostic value of early endoscopy in patients suspected of developing IgA vasculitis.