IgA vasculitis (formerly Henoch-Schönlein purpura) in an adult with systemic lupus erythematosus

Exploring the Diagnostic Odyssey of IgA Vasculitis

IgA vasculitis is a form of small vessel vasculitis characterized by IgA immune complex deposition. Although primarily affecting children, it can also occur in adults, often with more severe manifestations and a higher risk of chronic kidney disease (CKD). The authors present the case of a 77-year-old man with significant cardiovascular risk and atrial fibrillation who was admitted to the emergency department (ED) with pruritic and painful palpable purpuric rash, weight loss, and asthenia persisting for approximately one month prior to presentation. Laboratory findings revealed normocytic normochromic anemia, worsening renal function, elevated inflammatory markers, and leukoerythrocyturia. Initially diagnosed as infectious purpura associated with urinary tract infection, the patient was discharged with a prescription for antibiotics (cefixime). Subsequent worsening of the skin lesions, constitutional symptoms, and gross hematuria prompted a second visit to the ED, and the persistent deterioration of kidney function and inflammatory parameters led to admission for further investigation and consideration of a kidney biopsy. This case report describes the etiological investigation, providing a brief review of the typical characteristics of this disease and highlighting the importance of certain factors in establishing the diagnosis, notably the need and timing of a biopsy of the affected organ for a definitive diagnosis. Additionally, the clinical case underscores the diagnostic challenge, particularly when histological confirmation is elusive.

Efficacy and safety of low-dose corticosteroid with azathioprine in the treatment of elderly-onset IgA vasculitis with nephritis

The diagnosis of elderly-onset IgA vasculitis (IgAV) and its prognosis can be difficult to ascertain because of its rarity and the frequent presence of comorbidities. Furthermore, the treatment of elderly-onset IgAV remains controversial. We report a case of IgAV in an 87-year-old patient. Renal involvement was detected early during the IgAV follow-up. He was treated with low-dose corticosteroid and azathioprine, which led to a complete remission without any adverse effects. This suggests that precise intervention with early diagnosis and careful renal follow-up may prevent renal failure and that low-dose steroids with azathioprine can be an effective treatment for elderly-onset IgAV with nephritis.

Low-dose corticosteroid with mizoribine might be an effective therapy for elderly-onset ISKDC grade VI IgA vasculitis

Both the diagnosis of elderly-onset IgA vasculitis (IgAV) and its prognosis can be difficult because of its rarity and the likely presence of comorbidities. Furthermore, the treatment of elderly-onset IgAV remains controversial: the ideal dosages of corticosteroid and/or immunosuppressants have not been determined. In the elderly, corticosteroid adverse effects can lead to severe outcomes, and a consensus regarding its benefit and risk balance has not been reached. We report a case of IgAV in an 89-year-old patient who was admitted to our hospital to investigate a 30-day history of palpable purpura and pitting edema on her leg. A renal biopsy showed membranoproliferative glomerulonephritis with IgA deposits (The International Study of Kidney Disease in Children (ISKDC) grade VI), which is a predictor of a poor prognosis; these findings led to early intervention with low-dose corticosteroid (15 mg/day) and mizoribine. As a result, a complete remission without obvious adverse effects was obtained. Early intervention with low-dose corticosteroid and mizoribine based on renal histopathology results might be an effective treatment for elderly-onset ISKDC grade VI IgAV.