Een vrouw van middelbare leeftijd met recidiverende diarreeklachten sinds jaren

Abstract

A middle-aged woman with recurrent diarrhoea since years The case of a 49-year-old woman with abdominal discomfort since years, presenting with bloody diarrhoea and the recent development of joint pain and petechiae, is described. Laboratory analysis showed slightly elevated inflammatory parameters, as well as an elevated IgA level. Urinalysis showed microscopic haematuria and a significant proteinuria of 2.61 g/L, suspecting a glomerular pathology. The further investigation with autoimmune serology and protein electrophoresis was negative. A colonoscopy and kidney biopsy were performed. The colonoscopy demonstrated vasculitis at the terminal ileum. On the kidney biopsy, immunofluorescence showed IgA deposition in the mesangium, endocapillary injury and crescent formation, proving the diagnosis of IgA vasculitis complicated with renal involvement. IgA vasculitis, also known as Henoch-Schönlein purpura, is a systemic leukocytoclastic vasculitis affecting the small blood vessels. It is a typical childhood disease; almost 90% of the patients are children. The pathogenesis of the disease remains mainly unknown. The IgA level is raised, probably provoked by the presentation of an antigen to the mucosa-associated lymphoid tissue. Renal damage in adults is more frequent and severe, and therefore connected to morbidity.