Jornal de Vasculite

Atypical Characteristics of Skin Eruption in Adult Iga Vasculitis should not Deter from Diagnosis: Observations from a Retrospective Case Series

Abstract

Brenna G. Kelly1*, S. Mesgarzadeh1, D.B. Stratton1, I. Abraham2 and C. Curiel-Lewandrowski1

IgA vasculitis is poorly understood in adults and there is a greater need for randomized control trials to identify the clinical course and proper management of the disease. This is especially critical for adults with IgA vasculitis, given the association with worse outcomes and greater morbidity and mortality related to the disease’s comorbidities. For this reason, prompt identification and diagnosis of the vasculitis is critical. Importantly, cutaneous eruption is the most common presenting sign of IgA vasculitis, and it may be the only feature available to determine initial suspicion for IgA vasculitis. Atypical cutaneous features, such as necrotic or hemorrhagic purpura, bullae, or pustules, are more common in the cutaneous eruption of adult IgA vasculitis. This complicates identifying an already rare vasculitis in adults and could lead to delays in identification and management of the associated comorbidities. In this retrospective case series, we studied 34 adult patients with biopsy proven IgA vasculitis and divided each case into one of three different groups based on the dermatology providers’ differential diagnosis and initial clinical suspicion for IgA vasculitis at the time of biopsy. We then evaluated whether the proportion of patients with atypical cutaneous features differed across the groups. Atypical cutaneous features were significantly more common in cases where IgA vasculitis was not included in the differential compared to cases where IgA vasculitis was included. This suggests that atypical cutaneous features could be deterring clinicians from considering and identifying the vasculitis. This has implications for patient care related to the disease’s comorbidities and steps should be taken to emphasize that atypical cutaneous features are a common occurrence in adult IgA vasculitis.