Year: 2025
Type: article
Study design: Case Report
Abstract: A 41-year-old man presented with abdominal pain, purpura, and petechial hemorrhages on his abdominal wall and lower legs. His extremities were covered with multiple purpura and chronic and acute lesions that were fused and showed diffuse hyperpigmentation (Figure 1a). Skin biopsy suggested IgA vasculitis (Supplementary Figure S1). Esophagogastroduodenoscopy, performed due to worsening abdominal pain, showed multiple circular-shaped ulcers centred on the descending duodenal limb and prominent mucosal haemorrhages. The mucosa was oedematous and hyperaemic (Figure 1b). No ulcers or erosions were observed in the oesophagus or stomach, and capsule endoscopy revealed no abnormalities in the small intestine. Subsequently, the patient was diagnosed with IgA vasculitis, with multiple duodenal ulcers considered to have resulted from IgA vasculitis. Abdominal pain and extremity purpura improved immediately following oral steroid administration. Further esophagogastroduodenoscopy was performed, and multiple duodenal ulcers had healed and disappeared (Figure 1c). (a) Multiple purpura on the lower legs. (b) Esophagogastroduodenoscopy showing multiple circular-shaped ulcers and oedematous and hyperaemic mucosa on the duodenum. (c) The multiple duodenal ulcers had healed and disappeared following oral steroid administration IgA vasculitis-induced gastrointestinal involvement occurs in 50%-85% of cases1 and before a skin rash in 10%-40% of cases.2 Intestinal tract thickening is mostly observed on computed tomography, whereas endoscopy facilitates ulcer identification, mucosal erythema, and purpura.3 While glucocorticoid and cyclophosphamide use in managing gastrointestinal lesions in adults remains controversial owing to variation between patients,4 glucocorticoid therapy was successful herein. T.S. conducted the literature search, edited the manuscript, and prepared the figures. M.M. treated the patient and edited the manuscript. K.K. treated the patient and edited the manuscript. K.H. made the pathological diagnoses, edited the manuscript, and prepared the figures. No funding was received in relation to this study. Conflict of interest disclosure forms (ICMJE) have been collected for all co-authors and can be accessed as supplementary material here. Not applicable. Written consent was obtained from the patient to publish their data. The data that support the findings of this study are available from the corresponding author, T.S., upon reasonable request.
DOI: 10.1093/jcag/gwae062
Institutions: Japanese Red Cross Kanazawa Hospital, Kanazawa University
Language: English
Subfield: Rheumatology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,198
OpenAlex ID: W4407269232