Severe IgA vasculitis with features of remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome in a 60‐year‐old male treated with plasmapheresis

Objective:To explore a possible association between systemic immunoglobulin A(IgA)vasculitis and RS3PE syndrome and to investigate specific treatment regimens for adults who present with IgA vasculitis with renal involvement.Methods:The patient was treated with plasmapheresis and fresh frozen plasma(FFP)every other day with 1g methylprednisolone daily for three days followed by oral prednisone taper.Mycophenolate mofetil twice daily and trimethoprim‐sulfamethoxazole for Pneumocystis jirovecii prophylaxis was started.In total the patient received two cycles of plasmapheresis and fresh frozen plasma.Results:The patient's renal function drastically improved with resolution of both abdominal pain and nausea.Conclusion:We illustrate a possible association between systemic IgA vasculitis and RS3PE syndrome,and this case demonstrates IgA vasculitis with renal involvement that acutely resolved with high‐dose glucocorticoids and plasmapheresis.Additionally,our specific treatment regimen can be a potential standard of care for adults who present with IgA vasculitis with renal involvement.

An Atypical Cause of Abdominal Pain in an Elderly Patient

Background: Henoch-Schonlein Purpura (HSP), or IgA vasculitis, is the most common vasculitis in children and is characterized by four symptoms: palpable purpura with no concurrent thrombocytopenia or coagulopathy, arthritis/ arthralgias, abdominal pain, and renal disease. HSP does occur in older patients at a much lower frequency. Objective: To discuss the atypical presentation of HSP in an elderly adult and the increased nephrogenic risks that are involved in this patient group. Case Presentation: We present the history, physical findings, laboratory results, and the clinical course of a 74-year-old Caucasian male with an atypical presentation of HSP. Our patient presented with severe gastrointestinal and cutaneous symptoms which occurred after the onset of abdominal pain. Biopsies demonstrated leukocytoclastic vasculitis in the skin and acute inflammation and hemorrhage in the gastrointestinal tract. The diagnosis was confirmed as IgA vasculitis following the renal biopsy. The patient’s symptoms improved with the administration of methylprednisolone. Conclusion: In adults with HSP there is greater concern regarding renal involvement and a greater risk of developing end-stage renal disease compared to children. The importance of recognizing HSP in the elderly is imperative for early diagnosis and appropriate treatment to limit renal damage.