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Paper text:
henoch - schnlein purpura ( hsp ) , a systemic iga vascultitis , is uncommon in adults , with an incidence rate of 0.1 to 1.2 per million in adults over 20 years old . this vasculitic syndrome can present as an uncommon cause of intestinal obstruction in older patients .
we report a case of an older woman with hsp presenting with small bowel obstruction and vasculitic rash .
we report a 67-year - old woman who presented with small bowel obstruction and skin rash .
skin biopsy revealed leukocytoclastic vasculitis with + iga granular deposition within the walls of superficial dermal vessels .
she continued to do well with normal kidney function at a 3-month follow - up visit .
hsp , a systemic iga vasculitis , is a predominantly pediatric vasculitis and is uncommon in adults . in adults ,
however , gastrointestinal manifestation is less common in older patients , and bowel perforation and obstruction are rare .
iga nephropathy ( igan ) is the most common primary glomerulonephritis ( gn ) in the world .
there is a peak incidence of igan in the second and third decades of life .
henoch - schnlein purpura ( hsp ) is uncommon in adults , with an incidence rate of 0.1 - 1.2 per million in adults over 20 years old .
this vasculitic syndrome can present as an uncommon cause of intestinal obstruction in older patients .
a 67-year - old woman presented to the hospital with a 7-day history of severe , diffuse abdominal pain associated with nausea and vomiting .
she simultaneously developed pain involving both her elbows with difficulty bending her arms and a blotchy red purpuric rash over of the lower extremities knee down [ figure 1 ] . a blotchy red purpuric rash over of the lower extremities knee down physical examination revealed an abdominal distention with increased bowel sound .
initial laboratory investigations revealed no leukocytosis with normal serum creatinine of 0.7 mg / dl .
urinalysis demonstrated microscopic hematuria and mild proteinuria . computed tomography ( ct ) of abdomen was performed [ figure 2 ] and demonstrated a segment of bowel edema with partial small bowel obstruction .
a direct immunofluorescent technique showed + iga granular deposition within the walls of many superficial dermal vessels .
she underwent kidney biopsy for evaluation for vasculitis , which confirmed the diagnosis of hsp with mild mesangial proliferative igan .
she had a bowel rest and a nasogastric tube was placed for her partial small bowel obstruction .
computed tomography ( ct ) of the abdomen demonstrated a segment of bowel edema with partial small bowel obstruction
iga nephropathy ( igan ) is the most common primary glomerulonephritis ( gn ) in the world .
recently , a meta - analysis of 6,543 patients with igan demonstrated an increase in incidence of esrd in the older group .
. ninety percent of cases occur in the pediatric age group between the ages of 3 and 15 years .
hsp occurs uncommonly in adults with an incidence rate of 0.1 - 1.2 per million in adults over 20 years old . in adults ,
however , gastrointestinal manifestation is less common in older patients , and bowel perforation and obstruction are rare .
context : henoch - schnlein purpura ( hsp ) , a systemic iga vascultitis , is uncommon in adults , with an incidence rate of 0.1 to 1.2 per million in adults over 20 years old . 
 this vasculitic syndrome can present as an uncommon cause of intestinal obstruction in older patients . 
 we report a case of an older woman with hsp presenting with small bowel obstruction and vasculitic rash.case report : we report a 67-year - old woman who presented with small bowel obstruction and skin rash . 
 skin biopsy revealed leukocytoclastic vasculitis with + iga granular deposition within the walls of superficial dermal vessels . 
 kidney biopsy confirmed the diagnosis of hsp with mild mesangial proliferative iga nephropathy . 
 her abdominal pain and small bowel obstruction were improved with conservative treatment . 
 she continued to do well with normal kidney function at a 3-month follow - up visit.conclusion:hsp , a systemic iga vasculitis , is a predominantly pediatric vasculitis and is uncommon in adults . in adults , 
 the disease process is identical to that in children . 
 however , gastrointestinal manifestation is less common in older patients , and bowel perforation and obstruction are rare . 
 intestinal obstruction with skin rash and renal involvement should raise suspicions of hsp .