SHM Converge Scientific Abstract ePoster Gallery-Adult-Onset Henoch-Schönlein Purpura With Renal Sparing

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This case report describes a 34-year-old man with adult-onset Henoch-Schönlein purpura (IgA vasculitis, IgAV) after a group A streptococcal infection, notable for preserved renal function. IgAV is a small-vessel vasculitis classically seen in children, usually presenting with palpable purpura, arthralgia, abdominal pain, and possible kidney involvement. Adult cases are uncommon and more often associated with renal complications.<br /><br />The patient presented with fever, a rapidly progressive purpuric rash beginning at the ankles and spreading symmetrically, joint stiffness, scrotal and palmar swelling with residual ecchymoses, and a painful enlarging right neck mass. He had a recent self-limited sore throat and fever, plus travel and sexual exposure history. Exam showed widespread non-blanching petechiae concentrated around the ankles, wrists, thighs, and joints, along with tense right cervical swelling and a tongue ulcer.<br /><br />Laboratory testing revealed leukocytosis and markedly elevated inflammatory markers, elevated IgA, and normal complement levels. Renal function remained normal throughout admission. Extensive infectious workup was negative. CT of the neck showed bulky cervical adenopathy, necrotic lymph node, and intramuscular hemorrhage. Fine-needle aspiration and biopsy of the neck mass identified beta-hemolytic group A streptococci, supporting streptococcal-triggered IgAV.<br /><br />Dermatology concluded the presentation was most consistent with Henoch-Schönlein purpura secondary to streptococcal infection. The patient was treated with a 14-day course of amoxicillin-clavulanate and improved clinically. At follow-up, the rash had resolved, neck lymphadenopathy and ankle swelling were improving, and kidney function remained normal.<br /><br />The report emphasizes that although IgAV is primarily a pediatric disease, it should be considered in adults with post-infectious purpura and arthralgia. Prompt recognition is important because adults may have worse renal outcomes, and serial urinalysis monitoring is recommended even when initial renal function is normal.

Asset Subtitle

Nicole M. Leggiero

Meta Tag

Author List Nicole M. Leggiero, Ruta Shah, Tekle Didebulidze

Category Clinical Vignettes

Concept IgA Vasculitis

Concept Purpura

Concept Renal involvement

Concept Arthralgia

Concept Arthritis

Distinguished Non-Finalist

Presenter Organization Tufts University School of Medicine

Presenting Author Nicole M. Leggiero

Track Adult

Keywords

Henoch-Schönlein purpura

IgA vasculitis

adult-onset vasculitis

group A streptococcal infection

palpable purpura

arthralgia

renal function

cervical adenopathy

beta-hemolytic streptococci

amoxicillin-clavulanate

IgA Vasculitis

Purpura

Renal involvement

Arthralgia

Arthritis