Rupture of Microaneurysms in IgA Vasculitis
Emergency Medicine: Open Access

Emergency Medicine: Open Access
Open Access

ISSN: 2165-7548

Case Blog - (2015) Volume 5, Issue 2

Rupture of Microaneurysms in IgA Vasculitis

Yoshinosuke Shimamura* and Hideki Takizawa
Department of Nephrology, Teine Keijinkai Medical Center, Sapporo, Hokkaido, Japan
*Corresponding Author: Yoshinosuke Shimamura, MD, Department of Nephrology, Teine Keijinkai Medical Center, Sapporo, Hokkaido, Japan, Tel: 81-11-681-8111, Fax: 81-11-685-2196 Email:

Keywords: Palpable purpura; IgA vasculitis; Visceral microaneurysms; Arterial embolization

Case Report

IgA vasculitis is a small-vessel vasculitis associated with IgA-dominant immune deposits in the skin, kidney, and gastrointestinal tract. In adults, gastrointestinal features, including bloody diarrhea and microaneurysms, occur in 50% of patients [1].

A 64-year-old female with a history of hypertension presented with abdominal pain, fever, and progressive rash for one week. Physical examination revealed diffuse abdominal tenderness and palpable purpura in bilateral lower extremities (Figure 1).


Figure 1: Diffuse abdominal tenderness and palpable purpura in bilateral lower extremities.

Hemoglobin level was 12.3 g/dl, BUN 36 mg/dl, and serum creatinine level was 2.3 mg/dl. Urinary sediment showed 30-49 erythrocytes per high-power field. Purpuric lesions in the descending duodenum were found in upper gastrointestinal endoscopy (Figure 2).


Figure 2: Upper gastrointestinal endoscopy.

Both skin and duodenal biopsy revealed leukoclastic vasculitis with IgA deposition, and kidney biopsy revealed mesangial cell proliferation with IgA deposition, all of which consistent with IgA vasculitis. The patient died due to the rupture of visceral microaneurysms (Figure 3) although treated with arterial embolization as well as medical treatments with glucocorticoids pulse therapy combined with cyclophosphamide.


Figure 3: Rupture of visceral microaneurysms.

The pathogenesis of microaneurysms in IgA vasculitis is still unclear, but Ciccone MM et al. [2] reported that the complex inflammatory process in the disease contributes to develop atherosclerosis, which could damage the vascular endothelial cells [2].


  1. Pillebout E, Thervet E, Hill G, Alberti C, Vanhille P, et al. (2002) Henoch-Schonleinpurpura in adults: Outcome and prognostic factors. J AmSocNephrol 13: 1271-1278.
  2. Ciccone MM, Principi M, Ierardi E,Alfredob DL, Gabriellaa R, et al. (2015) Inflammatory bowel disease, liver diseases and endothelial function: is there a linkage? J Cardiovasc Med (Hagerstown)16: 11-21.
Citation: Yoshinosuke Shimamura (2015) Rupture of Microaneurysms in IgA Vasculitis. Emerg Med (Los Angel) 5:239.

Copyright: © 2015 Shimamura Y, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.