Diagnosing IgA Vasculitis in the Active Duty Population: The Importance of Early Diagnosis and Proper Biopsy Site Selection.

Immunoglobulin A associated vasculitis (IgAV), formerly called Henoch-Schönlein purpura, is a small vessel vasculitis which typically presents with upper and lower extremity palpable purpura and abdominal pain. It is the most common vasculitis in children, and is less common in adults. However, newer evidence suggests the incidence within the adult population is higher than previously reported. This case study demonstrates an adult military recruit presenting with new onset IgAV shortly after basic training. He noted a preceding upper respiratory tract infection, which is a common finding in those presenting with IgAV. The diagnosis was made by clinical findings, histopathological results and direct immunofluorescence. Adults tend to develop more necrotic and bullous lesions when compared with children. This can skew histopathology and direct immunofluorescence. There is no clear consensus in current literature for whether to obtain lesional or perilesional biopsies. Such recommendations could be particularly advantageous for adults given the abnormal lesions. This case study addresses the incidence of IgAV within the adult population, diagnostic criteria, long-term sequalea of IgAV, and the importance of a proper biopsy sight when making the diagnosis. Published by Oxford University Press on behalf of Association of Military Surgeons of the United States 2018.