Clinical Spectrum of Adult Henoch-Schönlein Purpura: Diagnostic Challenges and Long-Term Prognostic Considerations

Abstract

Immunoglobulin A vasculitis (IgAV) or Henoch–Schönlein purpura (HSP) is an immune complex-mediated systemic vasculitis that primarily affects small blood vessels in the skin, joints, gastrointestinal tract, and kidneys. Although more common in children, IgAV in adults tends to present with more severe symptoms and a higher risk of long-term kidney disease. IgAV is diagnosed based on clinical and histopathological criteria, with emphasis on non-thrombocytopenic palpable purpura, arthralgia/arthritis, abdominal pain, and/or kidney involvement, along with findings of leucocytoclastic vasculitis with IgA deposition on biopsy. Case Illustration: This case report describes a 20-year-old woman with palpable purpura on the lower legs and hands, arthralgia, a history of prior sore throat, and bronchial asthma with markedly elevated IgE. Laboratory findings showed elevated ESR and CRP; urinalysis was negative; skin biopsy revealed leucocytoclastic vasculitis. The patient was taking hormonal medication, methylprednisolone, and loratadine. This case demonstrates a typical presentation of IgAV in young adults, supported by a history of previous upper respiratory tract infection and atopic predisposition (bronchial asthma with high IgE). Clinical manifestations of palpable purpura on the extremities and arthralgia are highly consistent with IgAV. The leucocytoclastic vasculitis findings on skin biopsy are highly suggestive, although confirmation of IgA deposition remains ideal for definitive diagnosis. Management with corticosteroids and antihistamines aims to alleviate skin and joint inflammation. Long-term prognosis depends on close monitoring for potential development of IgAV nephritis.