Presentation
Rash on both legs for 3 days with intermittent severe abdominal pain and persistent back pain in the left thoracolumbar paraspinal area. No history of trauma.
Patient Data
There is a thickened duodenal loop, suggestive of mucosal hemorrhage. There is a
short ileal-ileal intussusception without any evidence of obstruction. The urinary bladder is distended and contains debris. The appearance suggests hemorrhage/blood clot.
Case Discussion
IgA vasculitis (IgAV), known previously as Henoch-Schonlein purpura (HSP) is a disease involving inflammation of small blood vessels. Abdominal ultrasonography can detect increased bowel wall thickness, hematomas, peritoneal fluid, and intussusception. In approximately 50% of patients with IgA vasculitis, renal function is affected. One common renal manifestation of IgAV is nephritis, due to which patients may experience hematuria and proteinuria and exhibit glomerular fibrin deposition with endocapillary/exocapillary inflammation.
The clinical diagnosis was based on the presence of classic manifestation of IgA vasculitis:
- Palpable purpura without thrombocytopenia and coagulopathy
- Arthritis/arthralgia, namely spinal tenderness
- Abdominal pain
- Renal disease
Afterwards, the patient was transported to another hospital for intussusception treatment.
Case courtesy of Dr Saman Perera.