28139 A case of IgA vasculitis associated with underlying cytomegalovirus colitis

Document Type

Conference Proceeding

Publication Date

9-1-2021

Publication Title

J Am Acad Dermatol

Abstract

A 62-year-old Caucasian female with history of treated hepatitis C virus (HCV) infection in remission, secondary liver cirrhosis, and idiopathic CD4 deficiency presented for admission with hematochezia and gastrointestinal discomfort. She also endorsed a 2-week history of petechial rash on her feet. A colonoscopy revealed ulcerated, friable mucosa at the hepatic flexure with a biopsy confirming CMV colitis. The patient was promptly started on IV valgalanyclovir. Dermatology was consulted for the rash with examination revealing numerous scattered purpuric macules and papules on the legs and feet. A punch biopsy revealed leukocytoclastic vasculitis, while a direct immunofluorescence (DIF) assay demonstrated 2+ granular staining in superficial dermal vessels for IgA, IgM, IgG, C3, and fibrinogen. The patient’s hospital course was complicated by worsening renal function, hematuria, and Staphylococcus epidermidis bacteremia treated with IV daptomycin. The patient was felt to have IgA vasculitis, but given her concurrent infections systemic immunosuppression was not recommended. Her cutaneous lesions, hematochezia, hematuria and renal function all ultimately improved with treatment of the patient’s underlying colitis. To our knowledge, this is the third case of IgA vasculitis as a complication of underlying CMV infection of the gastrointestinal tract.

Comments

https://doi.org/10.1016/j.jaad.2021.06.714

Volume

85

Issue

3

First Page

AB175

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