SHM Converge Scientific Abstract ePoster Gallery-Under the Surface: Adult Iga Vasculitis With a Thrombocytopenic Twist

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This case describes a severe presentation of IgA vasculitis (IgAV) in an 83-year-old man with seizures, CHF, HLD, OSA, and BPH who presented with altered mental status, progressive bilateral leg edema with bullae and draining wounds, and a spreading purpuric/hemorrhagic rash involving the extremities and face. He was also markedly hypoxic on arrival and required MICU admission.<br /><br />Initial evaluation raised concern for infection, thromboembolic disease, and autoimmune vasculitis. He was treated empirically with broad-spectrum antibiotics. Workup revealed DVTs in the left femoral and popliteal veins, EBV PCR positivity, and later skin biopsy confirming IgA vasculitis with nephropathy. Rheumatology considered other systemic causes, but pathology established the diagnosis. He was started on rituximab, atovaquone, pulse steroids, and then prednisone 60 mg daily.<br /><br />Despite treatment, his course was complicated by renal failure, pseudomonal bacteremia with refractory hypotension requiring vasopressors, and septic cardiomyopathy leading to cardiogenic shock. Given his deterioration, care was transitioned in alignment with his wishes to DNR status.<br /><br />The discussion emphasized that IgAV is typically self-limited in children but can be more severe and prognostically serious in adults, especially due to renal involvement. Poor renal markers such as proteinuria, hematuria, hypertension, and impaired kidney function predict worse outcomes, with some high-risk patients progressing to ESRD. Adult treatment lacks standardized guidelines; severe disease may require immunosuppression such as steroids, cyclophosphamide, rituximab, or mycophenolate. The case highlights the importance of early recognition, biopsy confirmation, and multidisciplinary management in adults with severe cutaneous, renal, and systemic IgAV.

Asset Subtitle

Tina J. Kana

Meta Tag

Author List Ethan Fried, Hehui Quan, Rebecca Zeidman, Tina J. Kana

Category Clinical Vignettes

Concept IgA Vasculitis

Concept Clinical Presentation

Concept Renal involvement

Concept Kidney Outcome

Concept Pathophysiology

Distinguished Non-Finalist

Presenter Organization Lenox Hill Hospital

Presenting Author Tina J. Kana

Track Adult

Keywords

IgA vasculitis

IgAV

adult vasculitis

purpuric rash

renal involvement

nephropathy

rituximab

septic shock

cardiogenic shock

skin biopsy

IgA Vasculitis

Clinical Presentation

Renal involvement

Kidney Outcome

Pathophysiology