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IgA-associated vasculitis (IgAV) known as Henoch - Schönlein purpura (HSP) disease is an inflammatory disorder of small blood vessels. It's the most common type of systemic vasculitis in children which can be associated with the inflammatory process following infections. IgA vasculitis is a rare and poorly understood systemic vasculitis in adults. Coronavirus disease 2019 (COVID-19) has been associated with HSP in both adults and children. A 58-year-old woman was diagnosed with HSP, fulfilling the clinical criteria: palpable purpura, arthritis, hematuria. The disclosure of the HSP disease was preceded by a infection of the respiratory tract. COVID-19 infection was confirmed via the presence of IgM and IgG antibodies. This case indicates the possible role of SARS-CoV-2 in the development of HSP. The clinical course of IgAV in adults appears to be different from pediatric IgAV, especially due to higher risk of renal complications. Symptoms of the disease quickly resolved with low-dose of steroids. [ABSTRACT FROM AUTHOR]

Cutaneous lesions of secondary syphilis are highly infectious and can mimic many skin disorders, making the diagnosis more difficult. They typically present as generalized, nonpruritic erythematous-to-copper-colored macules and papules, characteristically involving palms and soles. In 80% of patients the rash develops insidiously. However, rare forms of secondary syphilis present as rapidly progressive papulopustular lesions. These forms of syphilis are usually associated with human immunodeficiency virus infection and immunosuppression. We report a case of secondary syphilis presenting with an acute, rapidly progressive purpuric eruption mimicking leukocytoclastic vasculitis. A 61-year-old man presented with a 6-day history of nonpruritic rash on his chest and lower extremities associated with fatigue, sore throat, and night sweats. Examination revealed purpuric papules, extending from the dorsal feet to the hips; mucosal surfaces were not involved. A diagnosis of cutaneous small-vessel vasculitis was favored with possible triggers of IgA vasculitis. Initial work-up showed acute kidney injury and microscopic hematuria. Renal biopsy showed IgA nephropathy with mesangioproliferative glomerulonephritis. The patient's rash progressed to cover almost his entire body sparing palms and soles. Skin biopsy showed heavy perivascular lymphoplasmacytic infiltrate, capillary endothelial cell swelling, and sparse perivascular neutrophilic nuclear dust. Spirochetal stain highlighted scattered epidermal and dermal organisms.

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Copyright of Gaceta Médica de Caracas is the property of Academia Nacional de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Objectives Cutaneous IgM/IgG vasculitis (IgM/IgG V) is characterized by leukocytoclastic vasculitis histologically and by IgM‐ or IgG‐ perivascular deposition. However, clinical differences between IgM/IgG V and skin‐limited IgA vasculitis (IgA V) have not been fully clarified. In the present study, we assessed the clinical and histopathological differences between IgM/IgG V and IgA V. Methods We examined 14 patients with IgM/IgG V and 24 patients with skin‐limited IgA V. The cases associated with systemic diseases were excluded. Clinical findings, laboratory data, and histological findings were compared between IgM/IgG V and IgA V groups. Results Livedo lesions appeared more often, and palpable purpura less often in IgM/IgG V. Localization of the lesions was more limited to the lower legs in IgM/IgG V. In laboratory data, there were no statistical differences in peripheral blood cell counts, IgG, IgA, and IgM levels between the two groups. Histopathological findings showed less infiltration of neutrophils, CD8+ T cells, and CD3+ T cells, and nuclear dusts in IgM/IgG V. Systemic steroids were administered significantly less frequently in IgM/IgG V cases, but the recurrence rate did not differ. Conclusions Based on these results, IgM/IgG V may be a clinically and histologically different entity from IgA V. However, further studies are necessary to define the differences between them more clearly.

Abstract Immunoglobulin A vasculitis (IgAV) is a type of vasculitis affecting small vessels with deposition of immune complexes consisting of IgA and complement component 3. IgAV involves the skin, gastrointestinal (GI) tract, joints, and kidneys. Adult patients have higher risks of gastrointestinal tract involvement than children. To investigate the risk factors of the GI tract involvements in adult IgAV patients, we enrolled 29 adult (aged ≥ 20 years) Japanese patients recently (from 2013 to 2019) histopathologically diagnosed with IgAV and classified them into the GI lesion (+) group and the GI lesion (−) group. All patients presented with purpura on the lower extremities; moreover, GI lesion (+) patients presented significantly more with extensive purpura on the upper extremities, and low levels of factor XIII activity (≤70%) than gastrointestinal lesion (−) patients (87.5% vs 28.6% [P = .004]; odds ratio [OR], 17.5; 95% confidence interval [CI], 2.4 to 366], and 57.1% vs 14.3% [P = .04]; OR, 8; 95% CI, 1.06 to 83.9, respectively). There was no significant difference between the two groups in the populations with extensive purpura on the trunk, arthralgia, hematuria, proteinuria, or elevated serum levels of C‐reactive protein or IgA. Widespread purpura on the upper extremities accompanied by a low factor XIII activity is a suggestive factor for severe GI lesions in adult IgAV patients.

A 34-year-old White male presented with a persistent rash on the lower extremities characterized by erythema, liquid drainage, and severe burning pain. Initially misattributed to contact dermatitis, the condition worsened despite treatment with prednisone and doxycycline. Leukocytoclastic vasculitis (LCV) was confirmed via punch biopsy. The patient's treatment involved conservative measures, systemic prednisone therapy, doxycycline, and later adjunctive dapsone. Nevertheless, the patient developed secondary bacterial infection with methicillin-sensitive Staphylococcus aureus and Pseudomonas aeruginosa . This case highlights an uncommon presentation of idiopathic LCV that led to sepsis and reviews management for persistent vasculitis., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Jacobs et al.)

IgA vasculitis is a form of small vessel vasculitis characterized by IgA immune complex deposition. Although primarily affecting children, it can also occur in adults, often with more severe manifestations and a higher risk of chronic kidney disease (CKD). The authors present the case of a 77-year-old man with significant cardiovascular risk and atrial fibrillation who was admitted to the emergency department (ED) with pruritic and painful palpable purpuric rash, weight loss, and asthenia persisting for approximately one month prior to presentation. Laboratory findings revealed normocytic normochromic anemia, worsening renal function, elevated inflammatory markers, and leukoerythrocyturia. Initially diagnosed as infectious purpura associated with urinary tract infection, the patient was discharged with a prescription for antibiotics (cefixime). Subsequent worsening of the skin lesions, constitutional symptoms, and gross hematuria prompted a second visit to the ED, and the persistent deterioration of kidney function and inflammatory parameters led to admission for further investigation and consideration of a kidney biopsy. This case report describes the etiological investigation, providing a brief review of the typical characteristics of this disease and highlighting the importance of certain factors in establishing the diagnosis, notably the need and timing of a biopsy of the affected organ for a definitive diagnosis. Additionally, the clinical case underscores the diagnostic challenge, particularly when histological confirmation is elusive., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Rosmaninho et al.)

This case follows an adult middle-aged female patient who developed a purpuric rash, soreness, and swelling on her legs after walking for several days in Las Vegas. With no prior petechial rash history or presence of systemic symptoms, exercise-induced purpura (EIP) was suspected due to her protracted walking in warm weather. She recovered fully with supportive treatment. EIP, also known as exercise-induced vasculitis (EIV), is often poorly recognized, misdiagnosed, and inappropriately treated. There is a need for increased awareness and clinical diagnosis of EIV based on thorough history and physical examination., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Camejo et al.)

Objectives: Cutaneous IgM/IgG vasculitis (IgM/IgG V) is characterized by leukocytoclastic vasculitis histologically and by IgM‐ or IgG‐ perivascular deposition. However, clinical differences between IgM/IgG V and skin‐limited IgA vasculitis (IgA V) have not been fully clarified. In the present study, we assessed the clinical and histopathological differences between IgM/IgG V and IgA V. Methods: We examined 14 patients with IgM/IgG V and 24 patients with skin‐limited IgA V. The cases associated with systemic diseases were excluded. Clinical findings, laboratory data, and histological findings were compared between IgM/IgG V and IgA V groups. Results: Livedo lesions appeared more often, and palpable purpura less often in IgM/IgG V. Localization of the lesions was more limited to the lower legs in IgM/IgG V. In laboratory data, there were no statistical differences in peripheral blood cell counts, IgG, IgA, and IgM levels between the two groups. Histopathological findings showed less infiltration of neutrophils, CD8+ T cells, and CD3+ T cells, and nuclear dusts in IgM/IgG V. Systemic steroids were administered significantly less frequently in IgM/IgG V cases, but the recurrence rate did not differ. Conclusions: Based on these results, IgM/IgG V may be a clinically and histologically different entity from IgA V. However, further studies are necessary to define the differences between them more clearly. [ABSTRACT FROM AUTHOR]

Background: Purpura in inpatients commonly leads to dermatologic consultation. The differential diagnosis is broad and algorithms are intricate.Objective: We evaluated inpatient consultations for complex purpura to document the most common diagnoses and to validate the true diagnostic utility of histopathology, clinical morphology, and distribution.Methods: We reviewed a case series of 68 inpatients during a 4-year period with a dermatologic consultation for purpura and biopsy findings of vasculitis or microvascular occlusion.Results: Key features of complex purpura are nonbranching (round) versus branching (retiform) morphology, dependent versus acral or generalized distribution, and leukocytoclastic vasculitis versus microvascular occlusion (with emphasis on depth of involvement). Dependent nonbranching purpura with only superficial vessels involved by leukocytoclastic vasculitis was most often due to IgA vasculitis or cutaneous single-organ small-vessel vasculitis. In contrast, deeper involvement by leukocytoclastic vasculitis was suggestive of systemic disease (eg, antineutrophil cytoplasmic antibody-associated vasculitis). Branching purpura was concerning, with greater than 90% sensitivity and specificity for microvascular occlusion and associated high mortality (≈50%). The majority of patients who died had acral branching lesions.Limitations: Small sample size, inpatients at a tertiary care center, and retrospective nature are some limitations.Conclusion: Nonbranching dependent purpura corresponded to leukocytoclastic vasculitis, with the most common diagnoses being IgA vasculitis or skin-limited small-vessel vasculitis; patients with deep involvement often had systemic diseases. In this series, branching purpura was due to microvascular occlusion rather than medium-vessel vasculitis, and had associated high mortality. [ABSTRACT FROM AUTHOR]

Leukocytoclastic vasculitis has been reported in the setting of COVID‐19 infection and post‐COVID‐19 vaccination. We report a case of IgA vasculitis (IgAV) post‐COVID‐19 vaccination, with immunoglobulin A (IgA) immune deposits in the skin and renal involvement. SARS‐CoV spike protein immunohistochemical staining was negative. IgAV with skin and renal involvement is a potential reaction to COVID‐19 vaccination. [ABSTRACT FROM AUTHOR]

Immunoglobulin A (IgA) vasculitis is characterized by small vessel vasculitis involving immune complexes and IgA deposition. The development of heparin-induced thrombocytopenia (HIT) during IgA vasculitis is extremely rare. An 87-year-old man presented with general fatigue, leg edema, purpura, arthritis and renal disease. He was diagnosed with IgA vasculitis and was admitted to our hospital. Hemodialysis with heparin was initiated thrice a week on post-admission Day 11. On Day 21, during hemodialysis, the pressure in the dialysis circuit increased and the dialysis was interrupted. On Day 24, the platelet count rapidly decreased to 18 000/μl. The patient was diagnosed with HIT after testing positive for HIT antibodies; heparin was discontinued at this time. Precautions must be taken against the onset of HIT when initiating hemodialysis in patients with IgA vasculitis. [ABSTRACT FROM AUTHOR]

Linagliptin is a member of “Dipeptidyl Peptidase-4” (DPP-4) inhibitors and may be preferred for certain advantages. We present a type 2 diabetes case with developed skin findings after initiation of linagliptin. A 66-year-old type 2 diabetic woman with coronary heart disease for 10 years was admitted to our clinic with dry mouth, polydipsia and polyuria. She was on metformin, acetylsalicylic acid and nitrate treatment. The physical examination was unremarkable. On admission, blood glucose was 319 mg/dL, urine ketone was negative, serum biochemistry and arterial blood gas results were within normal limits. Linagliptin was added to treatment after glycemic regulation was achieved with intensive insulin regimen. On the second day of linagliptin treatment, palpable purpuralike lesions were seen in the lower and upper extremities. Linagliptin was considered as an etiological factor. After discontinuation of linagliptin, the lesions gradually regressed. DPP-4 inhibitors may lead to some dermatological side effects due to inhibition of other DPP enzymes. To the best of our knowledge, our case is the first case in the literature to develop palpable purpura after linagliptin treatment.

Immunoglobulin A vasculitis (IgAV) is a type of vasculitis affecting small vessels with deposition of immune complexes consisting of IgA and complement component 3. IgAV involves the skin, gastrointestinal (GI) tract, joints, and kidneys. Adult patients have higher risks of gastrointestinal tract involvement than children. To investigate the risk factors of the GI tract involvements in adult IgAV patients, we enrolled 29 adult (aged ≥ 20 years) Japanese patients recently (from 2013 to 2019) histopathologically diagnosed with IgAV and classified them into the GI lesion (+) group and the GI lesion (−) group. All patients presented with purpura on the lower extremities; moreover, GI lesion (+) patients presented significantly more with extensive purpura on the upper extremities, and low levels of factor XIII activity (≤70%) than gastrointestinal lesion (−) patients (87.5% vs 28.6% [P =.004]; odds ratio [OR], 17.5; 95% confidence interval [CI], 2.4 to 366], and 57.1% vs 14.3% [P =.04]; OR, 8; 95% CI, 1.06 to 83.9, respectively). There was no significant difference between the two groups in the populations with extensive purpura on the trunk, arthralgia, hematuria, proteinuria, or elevated serum levels of C‐reactive protein or IgA. Widespread purpura on the upper extremities accompanied by a low factor XIII activity is a suggestive factor for severe GI lesions in adult IgAV patients. [ABSTRACT FROM AUTHOR]

Immunoglobulin A (IgA) vasculitis, also known as Henoch–Schönlein purpura, is a type of cutaneous small-vessel vasculitis. IgA vasculitis typically presents with nonblanching, palpable purpura favoring dependent sites and areas of trauma (Bolognia et al., 2014). In some cases, IgA vasculitis is associated with systemic disease—most commonly, kidney injury. Nevertheless, most cases of IgA vasculitis are self-limiting, and the disease resolves over weeks to months (Bolognia et al., 2017). [ABSTRACT FROM AUTHOR]

A 76 year-old female came to our observation one week after the vaccination with ChAdOx1 nCoV-19 AZD1222 for the onset of purpuric rash on her gluteal and legs regions associated with coxalgia and episodes of macrohaematuria. Henoch-Schönlein purpura (HSP) was diagnosed on the basis of the revised criteria developed by the European League Against Rheumatism, the Paediatric Rheumatology International Trials Organization, and the Paediatric Rheumatology European Society (EULAR/PRINTO/PRES). HSP is a common IgA-mediated small vessel vasculitis, typical of childhood, that affects several systems and is characterized by a tetrad of dermatological, abdominal, joint, and renal manifestations. The Etiology of HSP is not completely understood, but it was observed following upper respiratory tract infections, medications, vaccinations, and malignancies. HSP has previously been reported following immunization with various vaccines, mostly within 12 weeks post, suggesting a possible correlation. To our knowledge, this is the first report of the possible association between COVID-19 ChAdOx1 nCoV-19 AZD1222 and the onset of HSP in a previously healthy woman. No similar cases were reported amongst 23.848 participants in the ChAdOx1 nCoV-19 AZD1222 trial.

Pulmonary renal syndrome refers to an association of pulmonary and glomerular disease and includes disorders, such as the ANCA-associated vasculitides, anti-glomerular basement membrane antibody disease, systemic lupus erythematosus, and IgA vasculitis (Henoch-Schönlein purpura). We present the medical history of a 26-month-old boy with an extensive purpuric rash, involving the limbs, trunk, and face, who developed clinically significant pulmonary hemorrhage and renal involvement. Rapid recognition of this rare but potentially life-threatening condition is crucial. In this report, we discuss the differential diagnosis, diagnostic studies, and treatment options to consider when facing a young child presenting with a pulmonary renal syndrome.