IgA vasculitis in an adult diabetic male with rapidly progressive glomerulonephritis: A case study

Abstract

Rationale: IgA vasculitis or Henoch-Schonlein purpura is an immune complex mediated small vessel vasculitis characterized by clinical triad of arthritis, palpable purpura and gastrointestinal symptoms. It is commonly seen in children below 10-year-old, though adults may be affected. Patient’s Concern: A 40-year-old man with type-2 diabetes mellitus presented with fever, melena, palpable purpuric rash and hematuria with acute kidney injury, associated with nephrotic range proteinuria. Skin biopsy revealed leukocytoclastic vasculitis and renal biopsy showed IgA deposits in the mesangium and capillary loops with fibro cellular crescents confirming the diagnosis of IgA vasculitis with crescentic rapidly progressive glomerulonephritis. Diagnosis: IgA vasculitis with rapidly progressive glomerulonephritis. Interventions: The patient was treated with pulse intravenous methylprednisolone 500 mg/day for 3 days with tapering doses of oral prednisolone and intravenous cyclophosphamide (0.5 gm/m2 body surface area) under the cover of intravenous antibiotics for diabetic foot ulcer. Outcomes: Patient improved gradually with return to baseline creatinine after 3 months of follow up. Lessons: Rapidly progressive glomerulonephritis is a rare manifestation of IgA vasculitis and warrants special care and early treatment. The incidence of rapidly progressive glomerulonephritis in IgA vasculitis is unknown. It carries a high risk of progression to chronic kidney disease and thus should be treated as soon as feasible after diagnosis.

Keywords

• henoch-schonlein purpura
• iga vasculitis
• crescentic rapidly progressive glomerulonephritis
• type-2 diabetes mellitus