SHM Converge Scientific Abstract ePoster Gallery-Avoiding a Rash Conclusion: A Case of Adult Iga Vasculitis and the Cost of a Missed Diagnosis

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This case report describes a 76-year-old Hispanic man with adult-onset IgA vasculitis who initially presented with a two-week history of worsening diffuse palpable, non-blanching petechial rash, fever, severe extremity pain, and altered mental status. He had previously been treated for allergy, urinary tract infection, and pneumonia without improvement. His past medical history included hypertension, type 2 diabetes, and ischemic stroke.<br /><br />On evaluation, he had leukocytosis, thrombocytosis, hypernatremia, acute kidney injury, and urinalysis showing hematuria and proteinuria. CSF studies excluded meningococcal meningitis. Brain MRI showed acute-subacute infarcts and white matter changes. Chest CT revealed interstitial lung disease-type changes. Infectious, viral, and immunologic workups were negative. A skin biopsy confirmed small-vessel immune complex leukocytoclastic vasculitis, establishing the diagnosis of IgA vasculitis.<br /><br />During hospitalization, his mental status improved, but he developed severe lower gastrointestinal bleeding. Endoscopy and colonoscopy showed blood and clots throughout the colon without a clear source. Despite multiple transfusions, his condition worsened, and the family chose hospice care.<br /><br />The report emphasizes that IgA vasculitis is primarily a pediatric disease, but it can occur in adults and is often underdiagnosed because of its rarity. Adult cases commonly involve the skin, joints, kidneys, and gastrointestinal tract, and severe disease can lead to death from GI or renal complications. This case highlights how the rash was initially mistaken for an allergy and symptoms were misattributed, contributing to diagnostic delay.<br /><br />The key message is that clinicians should maintain a high index of suspicion for adult IgA vasculitis when purpura, hematuria/proteinuria, abdominal bleeding, and systemic symptoms occur, since earlier recognition may prevent serious outcomes.

Asset Subtitle

Carolina De La Porte

Meta Tag

Author List Ana Chavez Velasquez, Anjeliin Raju, Anunaya Aashish, Carolina De La Porte, Scott M. Keeney

Category Clinical Vignettes

Concept IgA Vasculitis

Concept Palpable Purpura

Concept Gastrointestinal Bleeding

Concept Hematuria

Concept Acute Kidney Injury

Distinguished Non-Finalist

Presenter Organization Texas Health Resources

Presenting Author Carolina De La Porte

Track Adult

Keywords

IgA vasculitis

adult-onset vasculitis

leukocytoclastic vasculitis

palpable purpura

petechial rash

hematuria

proteinuria

gastrointestinal bleeding

acute kidney injury

diagnostic delay

IgA Vasculitis

Palpable Purpura

Gastrointestinal Bleeding

Hematuria

Acute Kidney Injury