Immunoglobulin a vasculitis after a not so innocuous wasp bite

Abstract

Background: Immunoglobulin A vasculitis (IgAV), previously known as Henoch–Schonlein purpura (HSP), is the most common vasculitis in children. Previous studies have identified various triggers of IgAV, with infections being the most common. We present herein a 9-year-old girl who developed IgAV with nephritis following a wasp sting. Clinical Description: A 9-year-old girl presented to us with a history of wasp sting 7 days ago, followed by the appearance of reddish, raised rashes over the back of her lower limbs, which later spread all over the body. She also developed edema over the face, abdomen, and lower limbs along with pain abdomen. On examination, she was afebrile, was normotensive, and had periorbital edema and bilateral pedal edema with multiple discrete palpable, nonblanching purpura predominantly over the extensor surfaces of the lower and upper extremities and the trunk. Abdominal examination revealed no tenderness. Complete blood counts, blood urea, serum creatinine, and liver function tests were normal. Urinalysis showed microscopic hematuria and nephrotic range proteinuria. Skin biopsy of the lesions showed evidence of IgA vasculitis. Renal biopsy was suggestive of HSP nephritis class 3. Management and Outcome: She was managed with oral corticosteroids, mycophenolate mofetil, and enalapril and had remission of proteinuria. The renal function tests and blood pressure continue to be normal. Conclusion: Few case reports exist of IgAV precipitated by insect bites; however, we could not find any previous reports of IgAV with nephritis following a wasp sting in children. This report adds to existing knowledge regarding precipitating factors for IgAV in children.

Keywords

• henoch–schonlein purpura
• immunoglobulin a vasculitis
• nephritis
• wasp sting