Henoch-Schönlein purpura

Adult-onset immunoglobulin (IgA) vasculitis presenting as terminal ileitis is a rare clinical encounter which can mimic inflammatory bowel disease or infectious gastroenteritis. A high index of clinical suspicion is required to reach the correct diagnosis and to implement the appropriate management plans. Herein, we report a case of an elderly female presenting with a short history of abdominal pain, vomiting, bloody diarrhoea, fatigue and reduced appetite. Based on the blood tests and imaging, she was initially managed as having an infective or inflammatory bowel condition.

Henoch-Schönlein purpura (HSP) is a small vessel vasculitis with immunoglobulin A-dominant immune deposits found in vessel walls. It primarily affects children, is uncommon in adults and often under-recognised in the elderly population due to its rarity in this group. When a purpuric rash develops in an older person it is typically treated with antibiotics for presumed infection, rather than investigated as potentially HSP. It is important to recognise this condition, particularly in older adults, as diagnosis has implications for management and prognosis.