Flood Daniel, Barber Briana, Miletta Nathanial R
Department of Internal Medicine, David Grant Medical Center, 101 Bodin Circle, Fairfiled, CA.
Department of Dermatology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD.
Mil Med. 2018 Sep 1;183(9-10):e663-e666. doi: 10.1093/milmed/usx234.
Immunoglobulin A associated vasculitis (IgAV), formerly called Henoch-Schönlein purpura, is a small vessel vasculitis which typically presents with upper and lower extremity palpable purpura and abdominal pain. It is the most common vasculitis in children, and is less common in adults. However, newer evidence suggests the incidence within the adult population is higher than previously reported. This case study demonstrates an adult military recruit presenting with new onset IgAV shortly after basic training. He noted a preceding upper respiratory tract infection, which is a common finding in those presenting with IgAV. The diagnosis was made by clinical findings, histopathological results and direct immunofluorescence. Adults tend to develop more necrotic and bullous lesions when compared with children. This can skew histopathology and direct immunofluorescence. There is no clear consensus in current literature for whether to obtain lesional or perilesional biopsies. Such recommendations could be particularly advantageous for adults given the abnormal lesions. This case study addresses the incidence of IgAV within the adult population, diagnostic criteria, long-term sequalea of IgAV, and the importance of a proper biopsy sight when making the diagnosis.
免疫球蛋白A相关血管炎（IgAV），以前称为过敏性紫癜，是一种小血管血管炎，通常表现为上下肢可触及的紫癜和腹痛。它是儿童中最常见的血管炎，在成人中较少见。然而，最新证据表明成人人群中的发病率高于先前报道。本病例研究展示了一名成年新兵在基础训练后不久出现新发IgAV。他提到之前有上呼吸道感染，这在IgAV患者中是常见表现。诊断通过临床发现、组织病理学结果和直接免疫荧光检查做出。与儿童相比，成人往往会出现更多坏死性和大疱性病变。这可能会使组织病理学和直接免疫荧光检查结果出现偏差。目前文献中对于是获取病变部位还是病变周围组织进行活检尚无明确共识。鉴于病变异常，这样的建议对成人可能特别有利。本病例研究探讨了成人人群中IgAV的发病率、诊断标准、IgAV的长期后遗症以及诊断时选择合适活检部位的重要性。
