1929 Spots and Dots on the Skin and Stomach: Gastrointestinal Vasculitis

Abstract

INTRODUCTION: Immunoglobulin A (IgA) vasculitis is often seen in the pediatric population but can also be seen in the adult cohort. The classic histopathological finding in IgA vasculitis is leukocytoclastic vasculitis (LCV), which is a neutrophilic inflammation in post-capillary venules. Classic signs of LCV include palpable purpura, small vessel involvement, and less likely but also extracutaneous manifestations. We present a unique case of a gastrointestinal (GI) manifestation of LCV with angiodysplasia in the stomach and duodenum. CASE DESCRIPTION/METHODS: This is a 66-year-old female with a history of hypertension, chronic kidney disease stage III, hypothyroidism, a recent diagnosis of LCV (Figure 1) two weeks prior that returns to the hospital with a complaint of watery diarrhea, bright red blood per rectum, lower abdominal cramping, and nausea. Her vitals were unremarkable and her laboratory studies revealed elevated blood urea nitrogen (BUN), acute kidney injury, mild anemia, and leukocytosis. A computed tomography (CT) scan of her abdomen demonstrated extensive wall thickening, multifocal periduodenal inflammation, and diffuse ileal wall thickening (Figure 2). An esophagogastroduodenoscopy (EGD) revealed ulcerative esophagitis, helicobacter pylori negative duodenal ulcers, and multiple non bleeding angiodysplasias in the stomach and duodenum that were cauterized (Figure 3). A colonoscopy revealed a tubular adenomatous polyp that was removed. The patient’s symptoms resolved and she did not demonstrate any further bleeding. Her hemoglobin stabilized and she was able to tolerate a regular diet on discharge. DISCUSSION: Abdominal pain and bloody diarrhea can have a milieu of differentials. This patient clearly demonstrated a vasculitic GI manifestations with bowel wall thickening and inflammation on imaging, elevated BUN, anemia, bloody diarrhea, and a history of LCV. Having a proper suspicion and confirming this with imaging, endoscopy, and biopsy is imperative for the diagnosis. Without a thorough history and physical, undiagnosed vasculitis can lead to fatal consequences such as gastrointestinal hemorrhage, perforation, or more rarely infarction.