2021 Volume 20 Issue 2 Pages 65-72
A 33-year-old man developed purpura and pain in his lower legs 4 days before he was admitted to the hospital. A diagnosis of IgA vasculitis was made by skin biopsy of the purpura on the leg. He was treated using steroid therapy. However, he developed severe abdominal pain and ascites. Many ulcers on the intestine were found by endoscopy of the upper and lower gastrointestinal tract. Skin purpura exacerbated and ascended to his neck. A XIII inhibitor was started, but purpura and abdominal symptom did not improve. He then received steroid pulse therapy and endoxan therapy,which improved abdominal pain and purpura, and the steroid dose was reduced gradually. The activity of vasculitis was considered to be related to the serum CRP, D-dimer, and XIII levels. Three days after discharge, he developed perforation of the small intestinal, necessitating emergency intestinal resection and anastomosis. The cause of small intestinal perforation was unclear. Lower digestive tract ulceration due to IgA vasculitis may have remained even though the skin manifestation and ulcers of the upper gastrointestinal tract improved. During therapy for IgA vasculitis, if the amount of steroid is reduced, it is important to evaluate the lower digestive tract by abdominal ultrasonography and CT because endoscopy of the lower gastrointestinal tract cannot be performed frequently. Skin Research, 20 : 65-72, 2021
