Stadem Nathan, Ruter Sara, Sitenga Graison
University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.
Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.
S D Med. 2024 Oct;77(10):454-457.
IgA vasculitis is a small vessel vasculitis and while it represents the most common form of vasculitis in pediatric populations, it is rare in adults. This manuscript describes a case of skin limited IgA vasculitis in an 84-yearold Caucasian female. The patient presented for bilateral lower extremity rash that occurred roughly one month following a viral upper respiratory illness. Her rash initially began as small petechial macules around her ankles and progressed to large confluent ecchymoses with scattered petechiae and necrosis over the course of a month. The patient underwent extensive clinical and laboratory analysis for suspected vasculitis which revealed elevated serum IgA, moderate hematuria, pyuria, and an asymptomatic urinary tract infection on urinalysis, but had otherwise normal results on autoimmune testing. The patient underwent tissues biopsies of her bilateral lower extremity rashes which revealed pathology suggestive of leukocytoclastic vasculitis of dermal vessels. Nephrology evaluation revealed no acute renal pathologies and thus biopsy was deferred. Given the result of skin biopsies, elevated serum IgA, and previous viral prodrome, the diagnosis of IgA vasculitis was confirmed. The patient was treated with 40 mg prednisone daily which was tapered over 6 weeks. Following completion of her steroid taper the rashes appeared to be healing well with only residual erythema and no signs of recurrent or worsening purpura. She continues to follow with her medical specialist for potential systemic involvement, which currently remains negative.
IgA 血管炎是一种小血管血管炎，虽然它是儿科人群中最常见的血管炎形式，但在成人中很少见。本手稿描述了一例 84 岁白种女性的皮肤局限性 IgA 血管炎病例。患者因双侧下肢皮疹就诊，皮疹大约在病毒性上呼吸道疾病后一个月出现。她的皮疹最初始于脚踝周围的小瘀点斑疹，在一个月的时间里发展为大片融合性瘀斑，伴有散在的瘀点和坏死。患者因疑似血管炎接受了广泛的临床和实验室分析，结果显示血清 IgA 升高、中度血尿、脓尿，尿液分析显示无症状尿路感染，但自身免疫检测结果其他方面正常。患者接受了双侧下肢皮疹的组织活检，病理结果提示真皮血管白细胞破碎性血管炎。肾脏科评估未发现急性肾脏病变，因此推迟了活检。鉴于皮肤活检结果、血清 IgA 升高以及先前的病毒前驱症状，IgA 血管炎的诊断得以确诊。患者接受了每日 40 毫克泼尼松的治疗，并在 6 周内逐渐减量。在类固醇减量完成后，皮疹似乎愈合良好，仅残留红斑，没有紫癜复发或加重的迹象。她继续接受医学专家的随访，以监测是否有潜在的全身受累情况，目前结果仍为阴性。
