A case of refractory adult-onset IgA vasculitis whose abdominal symptoms were benefited from plasma exchange

Abstract

A 64-year-old woman came to our hospital for abdominal pain and palpable purpura on her lower legs. Pathological findings of skin biopsy revealed the leukocytoclastic vasculitis with IgA deposition. These findings as well as arthritis and acute kidney injury led to the diagnosis of IgA vasculitis. Abdominal pain with rebound tenderness and purpura were exacerbated regardless of starting large amount of prednisolone（PSL）together with factor XIII replacement, methylprednisolone pulse therapy and cyclophosphamide pulse（IVCY）therapy. Plasma exchange（PE）was added, and abdominal pain and purpura drastically improved.

Although several pediatric case reports have shown the effectiveness of PE for abdominal symptoms, there were very few reports of adult cases. Our case will provide good evidence to show the usefulness of PE for the treatment of IgA vasculitis abdominal symptoms that are refractory to standard immunosuppressive therapy.