A 44‐year‐old man with no medical history presented to the emergency department with a purpuric rash for 1 week. The rash originated in the trunk and upper extremities and progressed to involve the lower extremities over the next several days. Review of systems was unremarkable except for abdominal pain and scrotal pain. The abdominal pain was moderate in intensity, crampy, and not associated with meals or diarrhea. There was no dysuria, urgency, or burning with urination. There was no recent illness, travel history, or sick contact exposure. On physical examination, there was a nodular, nontender, non‐pruritic, and nonblanching purpuric violaceous rash involving the trunk, buttocks, scrotum, and lower extremities.
There was no pharyngeal erythema, petechiae, sinus tenderness, or lymphadenopathy. Laboratory tests showed an elevated serum IgA (478 mg/dL) with normal white blood cell count, serum creatinine, erythrocyte sedimentation rate, C‐reactive protein, liver function tests, SPEP, cryoglobulins, HIV and hepatitis serologies, serum complement, ANA, ANCA, and antistreptolysin O titer studies. Urinalysis showed no hematuria or proteinuria. Scrotal ultrasound showed mild left orchitis. Skin biopsy showed leukocytoclastic vasculitis, but direct immunofluorescence showed scattered IgA deposits in basement membrane zones sparing the vessels. The patient's clinical presentation was most consistent with Henoch–Schonlein purpura (HSP), and he was started on prednisone 60 mg with plans for a slow steroid taper over the next several weeks. His rash, abdominal pain, and scrotal pain improved over the next week.
HSP is a systemic small‐vessel vasculitis characterized by deposition of IgA complexes in tissues. Its cause is unclear, but postinfectious and autoimmune theories have been proposed. Usually, it has a self‐limited course, and its main clinical manifestations can be seen in skin, joints, the gastrointestinal tract, and the kidneys. Less frequently, other organs, such as the lungs, brain, and genitourinary tract, can be affected. HSP is found in all age groups but is most commonly seen in children. Ten percent of cases involve adults. The clinical features of HSP are more severe in adults, with a significantly increased risk for the development of renal failure. Abdominal and testicular pain are infrequent presentations in adults. Diagnosis involves the finding of palpable purpura in the presence of either diffuse abdominal pain, a biopsy showing predominant IgA deposition, arthritis or arthralgia, or renal involvement (hematuria or proteinuria). Treatment of mild cases is symptom based, but in patients with severe rash, severe abdominal pain, or renal or testicular involvement, steroids are indicated.
The purpose of this case report was to increase the awareness of HSP in an atypical patient population. Although HSP is not common in adults, the combination of palpable purpura with multiorgan involvement should make one consider the diagnosis and institute early treatment as indicated to prevent organ damage.
E. Loukas ‐ none
To cite this abstract:Loukas E. An Atypical Case of Henoch‐Schonlein Purpura in an Adult. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 328. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/an-atypical-case-of-henochschonlein-purpura-in-an-adult/. Accessed May 24, 2019.