A Case of Skin Limited IgA Vasculitis in an 84-Year-Old Female.

Abstract

IgA vasculitis is a small vessel vasculitis and while it represents the most common form of vasculitis in pediatric populations, it is rare in adults. This manuscript describes a case of skin limited IgA vasculitis in an 84-yearold Caucasian female. The patient presented for bilateral lower extremity rash that occurred roughly one month following a viral upper respiratory illness. Her rash initially began as small petechial macules around her ankles and progressed to large confluent ecchymoses with scattered petechiae and necrosis over the course of a month. The patient underwent extensive clinical and laboratory analysis for suspected vasculitis which revealed elevated serum IgA, moderate hematuria, pyuria, and an asymptomatic urinary tract infection on urinalysis, but had otherwise normal results on autoimmune testing. The patient underwent tissues biopsies of her bilateral lower extremity rashes which revealed pathology suggestive of leukocytoclastic vasculitis of dermal vessels. Nephrology evaluation revealed no acute renal pathologies and thus biopsy was deferred. Given the result of skin biopsies, elevated serum IgA, and previous viral prodrome, the diagnosis of IgA vasculitis was confirmed. The patient was treated with 40 mg prednisone daily which was tapered over 6 weeks. Following completion of her steroid taper the rashes appeared to be healing well with only residual erythema and no signs of recurrent or worsening purpura. She continues to follow with her medical specialist for potential systemic involvement, which currently remains negative.