Motojima Mai, Tanabe Yuki, Makino Fumihiko, Suzuki Hitoshi, Tomita Shigeki, Sasaki Shinichi, Takahashi Kazuhisa
Department of Respiratory Medicine, Juntendo University School of Medicine Graduate School of Medicine, Tokyo, JPN.
Department of Respiratory Medicine, Juntendo University Urayasu Hospital, Chiba, JPN.
Cureus. 2024 Dec 12;16(12):e75607. doi: 10.7759/cureus.75607. eCollection 2024 Dec.
IgA vasculitis (IgAV) generally occurs in young people and presents with a tetrad of symptoms: purpura, abdominal pain, arthralgia, and nephritis. However, it may have an atypical course without the typical tetrad. Diffuse alveolar hemorrhage (DAH), heart failure, and stroke are known complications of IgAV but are all very rare. We herein report a case of adult-onset IgAV that developed simultaneously with these rare complications without the typical tetrad. A 31-year-old man without any medical history presented with fever and blood-tinged sputum. Two months later, these symptoms worsened, and he was admitted to the hospital with DAH, nephritis, heart failure, and stroke. Initially, these symptoms were considered indicative of vasculitis syndrome, and he was finally diagnosed with IgAV based on the results of a renal biopsy. The treatment was successful with corticosteroids alone. IgAV should, therefore, be considered in the differential diagnosis when a patient presents with vasculitis syndrome, even with an atypical course.
IgA 血管炎（IgAV）通常发生于年轻人，表现为四联征症状：紫癜、腹痛、关节痛和肾炎。然而，它可能有非典型病程，无典型的四联征。弥漫性肺泡出血（DAH）、心力衰竭和中风是已知的 IgAV 并发症，但都非常罕见。我们在此报告一例成人起病的 IgAV，其同时出现这些罕见并发症且无典型四联征。一名无任何病史的 31 岁男性出现发热和痰中带血。两个月后，这些症状加重，他因弥漫性肺泡出血、肾炎、心力衰竭和中风入院。最初，这些症状被认为提示血管炎综合征，最终根据肾活检结果诊断为 IgAV。单独使用皮质类固醇治疗成功。因此，当患者出现血管炎综合征时，即使病程不典型，在鉴别诊断中也应考虑 IgAV。
