A 42-Year-Old Man with Skin Petechia and Palpable Purpura on His Legs

Differential Diagnosis

• Acute meningococcemia
• Cryoglobulinemia
• Henoch-Schönlein purpura
• Leukocytoclastic vasculitis

Figure 2.

Diagnosis
This patient has immunoglobulin A vasculitis (IgAV, formerly known as Henoch-Schönlein purpura), a necrotizing small-vessel vasculitis of unknown etiology that actually occurs more often in children than in adults. When it does occur in adults, it is seen more frequently in males, white individuals, and those of Asian descent.

Learnings

• IgAV is often characterized by palpable purpura, abdominal pain, arthritis, and hematuria. Adults are more likely to have joint symptoms and renal dysfunction; fever and abdominal pain is most common in children
• Renal involvement, if present, is usually self-limited. Risk of renal failure is higher in adult patients
• IgAV is sometimes preceded by an upper respiratory infection
• Episodes can be expected to last from 3 to 6 weeks

Pearls for Urgent Care Management and Considerations for Transfer

• Most cases of IgAV will resolve spontaneously; as such, treatment is symptomatic
• Patients should be advised to drink more fluids, get bed rest, and elevate affected areas if lower extremities are involved
• Use of steroids and/or immunosuppressors is controversial, but may be considered with severe gastrointestinal or renal manifestations