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Immunoglobulin A vasculitis without purpura in an elderly female patient: a case report
Immunoglobulin A (IgA) vasculitis mainly affects the joints, skin, kidneys, and gastrointestinal tract; however, purpura is an essential diagnostic criterion. Here, we report an unusual case of IgA vasculitis without purpura in an elderly woman. A 76-year-old woman was admitted to our hospital compl...
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Published in: | Clinical journal of gastroenterology 2021-08, Vol.14 (4), p.1090-1095 |
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creator | Murata, Masaki Yamazaki, Yuki Shimogama, Tsubasa Ota, Yoshiyuki Moriyoshi, Koki Miyamoto, Shin’ichi |
description | Immunoglobulin A (IgA) vasculitis mainly affects the joints, skin, kidneys, and gastrointestinal tract; however, purpura is an essential diagnostic criterion. Here, we report an unusual case of IgA vasculitis without purpura in an elderly woman. A 76-year-old woman was admitted to our hospital complaining of diarrhea and abdominal pain. No skin rash, purpura, jaundice, or peripheral lymphadenopathy was observed. Endoscopy of the small intestine revealed severe mucosal sloughing in the duodenum, and a biopsy specimen showed severe erosive duodenitis. A decrease in coagulation factor XIII (FXIII) activity was also observed during laboratory blood tests. IgA immunostaining revealed granular IgA deposition on the walls of the interstitial small blood vessels. Although the patient showed no purpura or renal involvement, a diagnosis of IgA vasculitis was made based on the histopathology findings from biopsies. The administration of purified FXIII concentrate improved her symptoms immediately and facilitated regeneration of the duodenal villi. When gastroenterologists encounter severe erosive duodenitis or inflammation of the small intestine, IgA vasculitis should be listed as part of the differential diagnosis even without purpura and/or renal involvement. For a definitive diagnosis, measurement of FXIII and IgA immunostaining using duodenal biopsy specimens should be performed actively. |
doi_str_mv | 10.1007/s12328-021-01422-6 |
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Here, we report an unusual case of IgA vasculitis without purpura in an elderly woman. A 76-year-old woman was admitted to our hospital complaining of diarrhea and abdominal pain. No skin rash, purpura, jaundice, or peripheral lymphadenopathy was observed. Endoscopy of the small intestine revealed severe mucosal sloughing in the duodenum, and a biopsy specimen showed severe erosive duodenitis. A decrease in coagulation factor XIII (FXIII) activity was also observed during laboratory blood tests. IgA immunostaining revealed granular IgA deposition on the walls of the interstitial small blood vessels. Although the patient showed no purpura or renal involvement, a diagnosis of IgA vasculitis was made based on the histopathology findings from biopsies. The administration of purified FXIII concentrate improved her symptoms immediately and facilitated regeneration of the duodenal villi. When gastroenterologists encounter severe erosive duodenitis or inflammation of the small intestine, IgA vasculitis should be listed as part of the differential diagnosis even without purpura and/or renal involvement. 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Here, we report an unusual case of IgA vasculitis without purpura in an elderly woman. A 76-year-old woman was admitted to our hospital complaining of diarrhea and abdominal pain. No skin rash, purpura, jaundice, or peripheral lymphadenopathy was observed. Endoscopy of the small intestine revealed severe mucosal sloughing in the duodenum, and a biopsy specimen showed severe erosive duodenitis. A decrease in coagulation factor XIII (FXIII) activity was also observed during laboratory blood tests. IgA immunostaining revealed granular IgA deposition on the walls of the interstitial small blood vessels. Although the patient showed no purpura or renal involvement, a diagnosis of IgA vasculitis was made based on the histopathology findings from biopsies. The administration of purified FXIII concentrate improved her symptoms immediately and facilitated regeneration of the duodenal villi. When gastroenterologists encounter severe erosive duodenitis or inflammation of the small intestine, IgA vasculitis should be listed as part of the differential diagnosis even without purpura and/or renal involvement. For a definitive diagnosis, measurement of FXIII and IgA immunostaining using duodenal biopsy specimens should be performed actively.</description><subject>Abdominal Surgery</subject><subject>Case Report</subject><subject>Colorectal Surgery</subject><subject>Gastroenterology</subject><subject>Hepatology</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Surgical Oncology</subject><issn>1865-7257</issn><issn>1865-7265</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kE1PwzAMhiMEYuPjD3BAOXIpOE6brNymiY9Jk7iAOEZp5o1O_SJpQfx7Ahs7Ilm2Jb9-ZT-MXQi4FgD6JgiUOEkARQIiRUzUARuLicoSjSo73PeZHrGTEDYACkHLYzaSMs9AKhiz13ldD027rtpiqMqGT_mHDS62fRn4Z9m_tUPPu8HHsDzObcOpWpKvvviKalsR72xfUtPfcsudDcQ9da3vz9jRylaBznf1lL3c3z3PHpPF08N8Nl0kTiL28Tib57qwqVDCaY16SSJLtSpkirmlrJC5I9RSCIppJaGY5OCyHNQSyBHIU3a19e18-z5Q6E1dBkdVZRtqh2AwQ0wBUkyjFLdS59sQPK1M58va-i8jwPwANVugJgI1v0CNikuXO_-hqGm5X_kjGAVyKwhx1KzJm007-Cb-_J_tN9N2gFg</recordid><startdate>20210801</startdate><enddate>20210801</enddate><creator>Murata, Masaki</creator><creator>Yamazaki, Yuki</creator><creator>Shimogama, Tsubasa</creator><creator>Ota, Yoshiyuki</creator><creator>Moriyoshi, Koki</creator><creator>Miyamoto, Shin’ichi</creator><general>Springer Singapore</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2298-0970</orcidid></search><sort><creationdate>20210801</creationdate><title>Immunoglobulin A vasculitis without purpura in an elderly female patient: a case report</title><author>Murata, Masaki ; Yamazaki, Yuki ; Shimogama, Tsubasa ; Ota, Yoshiyuki ; Moriyoshi, Koki ; Miyamoto, Shin’ichi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c322t-72a997ba4161c7727de15476b3429ae5b39ce27311e731f30b890c5906d0ece03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Abdominal Surgery</topic><topic>Case Report</topic><topic>Colorectal Surgery</topic><topic>Gastroenterology</topic><topic>Hepatology</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Surgical Oncology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Murata, Masaki</creatorcontrib><creatorcontrib>Yamazaki, Yuki</creatorcontrib><creatorcontrib>Shimogama, Tsubasa</creatorcontrib><creatorcontrib>Ota, Yoshiyuki</creatorcontrib><creatorcontrib>Moriyoshi, Koki</creatorcontrib><creatorcontrib>Miyamoto, Shin’ichi</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical journal of gastroenterology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Murata, Masaki</au><au>Yamazaki, Yuki</au><au>Shimogama, Tsubasa</au><au>Ota, Yoshiyuki</au><au>Moriyoshi, Koki</au><au>Miyamoto, Shin’ichi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Immunoglobulin A vasculitis without purpura in an elderly female patient: a case report</atitle><jtitle>Clinical journal of gastroenterology</jtitle><stitle>Clin J Gastroenterol</stitle><addtitle>Clin J Gastroenterol</addtitle><date>2021-08-01</date><risdate>2021</risdate><volume>14</volume><issue>4</issue><spage>1090</spage><epage>1095</epage><pages>1090-1095</pages><issn>1865-7257</issn><eissn>1865-7265</eissn><abstract>Immunoglobulin A (IgA) vasculitis mainly affects the joints, skin, kidneys, and gastrointestinal tract; however, purpura is an essential diagnostic criterion. Here, we report an unusual case of IgA vasculitis without purpura in an elderly woman. A 76-year-old woman was admitted to our hospital complaining of diarrhea and abdominal pain. No skin rash, purpura, jaundice, or peripheral lymphadenopathy was observed. Endoscopy of the small intestine revealed severe mucosal sloughing in the duodenum, and a biopsy specimen showed severe erosive duodenitis. A decrease in coagulation factor XIII (FXIII) activity was also observed during laboratory blood tests. IgA immunostaining revealed granular IgA deposition on the walls of the interstitial small blood vessels. Although the patient showed no purpura or renal involvement, a diagnosis of IgA vasculitis was made based on the histopathology findings from biopsies. The administration of purified FXIII concentrate improved her symptoms immediately and facilitated regeneration of the duodenal villi. When gastroenterologists encounter severe erosive duodenitis or inflammation of the small intestine, IgA vasculitis should be listed as part of the differential diagnosis even without purpura and/or renal involvement. For a definitive diagnosis, measurement of FXIII and IgA immunostaining using duodenal biopsy specimens should be performed actively.</abstract><cop>Singapore</cop><pub>Springer Singapore</pub><pmid>33950360</pmid><doi>10.1007/s12328-021-01422-6</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0003-2298-0970</orcidid></addata></record> |
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subjects | Abdominal Surgery Case Report Colorectal Surgery Gastroenterology Hepatology Medicine Medicine & Public Health Surgical Oncology |
title | Immunoglobulin A vasculitis without purpura in an elderly female patient: a case report |
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