A 41-year-old man presented with abdominal pain, purpura, and petechial hemorrhages on his abdominal wall and lower legs. His extremities were covered with multiple purpura and chronic and acute lesions that were fused and showed diffuse hyperpigmentation (Figure 1a). Skin biopsy suggested IgA vasculitis (Supplementary Figure S1). Esophagogastroduodenoscopy, performed due to worsening abdominal pain, showed multiple circular-shaped ulcers centred on the descending duodenal limb and prominent mucosal haemorrhages. The mucosa was oedematous and hyperaemic (Figure 1b). No ulcers or erosions were observed in the oesophagus or stomach, and capsule endoscopy revealed no abnormalities in the small intestine. Subsequently, the patient was diagnosed with IgA vasculitis, with multiple duodenal ulcers considered to have resulted from IgA vasculitis. Abdominal pain and extremity purpura improved immediately following oral steroid administration. Further esophagogastroduodenoscopy was performed, and multiple duodenal ulcers had healed and disappeared (Figure 1c).
Figure 1.
(a) Multiple purpura on the lower legs. (b) Esophagogastroduodenoscopy showing multiple circular-shaped ulcers and oedematous and hyperaemic mucosa on the duodenum. (c) The multiple duodenal ulcers had healed and disappeared following oral steroid administration
IgA vasculitis-induced gastrointestinal involvement occurs in 50%-85% of cases1 and before a skin rash in 10%-40% of cases.2 Intestinal tract thickening is mostly observed on computed tomography, whereas endoscopy facilitates ulcer identification, mucosal erythema, and purpura.3 While glucocorticoid and cyclophosphamide use in managing gastrointestinal lesions in adults remains controversial owing to variation between patients,4 glucocorticoid therapy was successful herein.
Supplementary Material
Contributor Information
Tsuyoshi Suda, Department of Gastroenterology, Kanazawa Red Cross Hospital, Kanazawa, Ishikawa 921-8162, Japan.
Miyabi Miura, Department of Gastroenterology, Kanazawa Red Cross Hospital, Kanazawa, Ishikawa 921-8162, Japan.
Kazuhiro Komura, Department of Dermatology, Kanazawa Red Cross Hospital, Kanazawa, Ishikawa 921-8162, Japan.
Kenichi Harada, Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Ishikawa 920-8640, Japan.
Author contributions
T.S. conducted the literature search, edited the manuscript, and prepared the figures. M.M. treated the patient and edited the manuscript. K.K. treated the patient and edited the manuscript. K.H. made the pathological diagnoses, edited the manuscript, and prepared the figures.
Funding
No funding was received in relation to this study.
Conflicts of interest
Conflict of interest disclosure forms (ICMJE) have been collected for all co-authors and can be accessed as supplementary material here.
Ethics approval
Not applicable.
Informed consent
Written consent was obtained from the patient to publish their data.
Data availability
The data that support the findings of this study are available from the corresponding author, T.S., upon reasonable request.
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The data that support the findings of this study are available from the corresponding author, T.S., upon reasonable request.