Orris

Hi

Hi there! How can I help you today?
attachment
attachment

Solve this

Reading File
Finding Sources
Finding Sources
Reading File
Reading File
Reading File
Loading Image

Diagnosis: IgA Vasculitis (Henoch-Schönlein Purpura / HSP)

The photograph the question refers to would show palpable purpura on the lower extremities - exactly like this classic textbook image:
Palpable purpura of lower limbs in HSP/IgA Vasculitis
Palpable purpura on the lower extremities - the hallmark skin finding of HSP/IgA Vasculitis

Why this diagnosis fits perfectly:

Feature in the caseHSP explanation
22-year-old maleCan occur in young adults (though more common in children)
Abdominal painGI involvement - colicky pain from bowel vasculitis
ArthralgiaJoint involvement (arthritis/arthralgia is one of the diagnostic criteria)
HaematuriaRenal involvement (IgA nephropathy/glomerulonephritis)
BP 180/100 mmHgHypertension from renal involvement
Photograph (implied)Palpable purpura on lower limbs - the mandatory criterion

Classic Tetrad of HSP/IgA Vasculitis:

  1. Palpable purpura (lower limb predominance) - MANDATORY for diagnosis
  2. Arthralgia / Arthritis
  3. Abdominal pain (colicky, GI bleeding possible)
  4. Renal involvement (haematuria, proteinuria)

Diagnostic Criteria (EULAR/PRINTO/PRES Ankara 2008):

  • Purpura is mandatory + at least one of: abdominal pain, histopathology (IgA deposition on leukocytoclastic vasculitis), arthritis/arthralgia, or renal involvement
  • This patient satisfies all four additional criteria

Pathogenesis:

  • Small-vessel IgA immune complex vasculitis (formerly called Henoch-Schönlein Purpura; renamed IgA Vasculitis at the 2012 Chapel Hill Consensus)
  • IgA1 deposits in vessel walls trigger complement and inflammation
  • Often preceded by an upper respiratory tract infection

Key points to remember for exams:

  • The skin biopsy shows leukocytoclastic vasculitis with IgA deposits (IgA on immunofluorescence)
  • Renal involvement (IgA nephropathy-like) determines long-term prognosis
  • Adults tend to have a more severe course than children
  • Treatment: supportive; steroids for severe abdominal/renal involvement
(Rheumatology, 2-Volume Set (Elsevier, 2022), Chapter 169)
This is a shared conversation. Sign in to Orris to start your own chat.