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*Corresponding author: E-mail: ashraf.alaqqad@gmail.com; 
 
 
 

Asian Journal of Immunology 
 
4(1): 120-124, 2021; Article no.AJI.77408 
 

 
 

 

 

Henoch-Schonlein Purpura Successfully Treated 
with Oral Steroids: A Case Report 

 
Mohamed Eltaieb Ali1, Ashraf Alakkad1* and Naglaa Mohamed Hamed2 

 
1
Internal Medicine Department, Madinat Zayed Hospital, UAE. 

2
Dermatology Department, Madinat Zayed Hospital, UAE. 

 
Authors’ contributions  

 
This work was carried out in collaboration among all authors. All authors read and approved the final 

manuscript. 
 

Article Information 
 

Editor(s): 
(1) Dr. Darko Nozic, University of Belgrade, Serbia. 

(2) Prof. Cynthia Aracely Alvizo Báez, Autonomous University of Nuevo Leon, Mexico. 
Reviewers: 

(1) Rosario Eça, Centro Hospitalar Lisboa Central, Portugal. 
(2) Simin Dokht Shoaei, SBMU, Iran. 

Complete Peer review History, details of the editor(s), Reviewers and additional Reviewers are available here: 
https://www.sdiarticle5.com/review-history/77408 

 
 
 

Received 20 September 2021  
Accepted 30 November 2021 
Published 01 December 2021 

 
 

ABSTRACT 
 

A 38-years old male patient, documented case of Irritable Bowel Syndrome (IBS), presented to the 
clinic with complaints of severe central abdominal pain and severe rash. The day before presenting 
to the clinic, the patient went to the Emergency Department for the same complaints.  
According to the patient, the abdominal pain was colicky in nature. There were no associated 
complaints of nausea, vomiting, or GI bleeding, but did have an upper respiratory tract infection 
three weeks ago, after which he had started experiencing these symptoms. His infection was 
treated with oral antibiotics and was soon got resolved. The staff at the ED had investigated the 
cause, including a CT abdomen with contrast, but the reports had been all clear. He had mildly 
raised serum creatinine at that time. 
On clinical examination, the patient had severe tenderness in his abdominal region. The rash was 
extensive, reddish, raised, and purpuric in nature and had spread all over his lower limbs and hips 
on both sides. The upper limbs were also involved up to the forearms. 
All the lab investigations conducted on the patient were normal, including CBC, Creatinine, Serum 
C3, C4, and the rheumatoid factor. CRP was found to be elevated and positive occult blood was 
seen in the stool of the patient. 
The combination of the above medical symptoms and investigations revealed that the patient was 
suffering from abdominal angina. The symptoms had a classic presentation pattern: positive occult 

Case Study 



 
 
 
 

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121 

 

blood in stool, a purpuric rash, abdominal pain, and renal involvement that was preceded by a 
documented case of upper respiratory tract infection (URTI). 
Later, the patient was found to have all findings consistent with immune-mediated IgA vasculitis 
(Henoch Schonlein Purpura) and was then treated accordingly. 
The above-mentioned case was an interesting presentation: the condition is not often presented to 
the hospital with such clear manifestations, leading to an absolute diagnosis. The following sections 
of this case study will explore how the patient was diagnosed, treated, and managed accordingly to 
save his life. 

 

 
Keywords: Henoch schonlein purpura; irritable bowel syndrome; GI bleeding; abdominal angina. 
 

1. INTRODUCTION 
 
Abdominal angina is a type of pain related to the 
gastrointestinal tract that is seen to occur mostly 
after meals when there is an insufficient supply of 
blood to the colon and it is unable to meet the 
demands of the rest of the viscera of the GI tract. 
Abdominal angina is most commonly seen to 
occur in cases of mesenteric occlusive vascular 
disease [1]. 
 
Abdominal angina gets its name from the 
intermittent claudication that occurs in similar 
cases of myocardial angina or vascular disease 
[2]. However, abdominal angina is a rare 
phenomenon, both in the United States as well as 
elsewhere in the world. This is because most 
cases of mesenteric occlusive disease get 
diagnosed early and so urgent evaluation and 
timely treatment ensure that no further 
complications develop in the patient [3]. 
 
However, since there were obvious signs of what 
the patient was suffering from, it was later on that 
it was concluded that abdominal angina might 
just be a part of his presenting symptoms. The 
spectrum of the symptoms were more than 
indicated by the diagnosis and that is why the 
patient underwent further examination and 
investigation to gain a more accurate indication 
of the condition that he was suffering from.Later 
on, the presence of abnormally elevated protein 
levels in the patient’s blood pointed to a condition 
similar to henoch Schonlein Purpura, but the 
normalcy of the rheumatoid factor and C4 tests 
lead to the exclusion of this diagnosis as well. 
Another trip to the dermatologist helped in 
confirm the diagnosis as Henoch Schonlein 
Purpura or IgA vasculitis. 
 

Henoch Schonlein Purpura is an IgA-mediated 
immune vasculitis that involves the small vessels 
of the gastrointestinal tract, kidneys, joints, skin, 
respiratory system and lungs. The presentation 
of the patient was considered to be classic of 

this condition which allowed for timely diagnosis 
and appropriate management to avoid 
complications in the long run [4]. 
 

2. CASE STUDY 
 

A 38-year old male patient, who appeared to be 
quite anxious and restless, presented to the 
clinic. This patient complained of having severe 
central abdominal pain and a skin rash. He had 
been to many hospitals and clinics, and nearly all 
of them had failed to diagnose what was wrong 
with him, despite there being obvious signs of 
illness, owing to his deteriorating state. 
 
Earlier, the patient was diagnosed with irritable 
bowel syndrome (IBS). The day before he went 
to the Emergency Department for the same 
complaints. The ED had promptly ordered lab 
investigations, along with a CT abdomen with 
contrast to rule out possible warning signs that 
might have developed insidiously inside the 
patient. The CT scan was completely normal. 
The same applies to the lab reports, except for a 
small rise in the levels of serum creatinine. 
 

2.1 Examination 
 
When the patient was thoroughly examined, the 
nature of his pain turned out to be colicky. 
However, the pain was not associated with any 
kind of nausea, vomiting, GI loss, or bleeding. 
The patient reported suffering from an upper 
respiratory tract infection about three weeks ago, 
for which he was treated successfully with oral 
antibiotics. 
 
The physical examination of the patient revealed 
that he was tearful and anxious because of his 
condition. He had obvious signs of central 
abdominal tenderness and there was an 
extensive rash which was raised, reddish and 
purpuric, across both the lower limbs and hips of 
the patient. The upper limb was also involved, 
but only up to the forearms of the patient. 



 
 
 
 

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122 

 

The following is an image of the patient’s rash, 
which has been used with the patient’s consent. 
 
Image 1 
 

 
 
Image 2 
 

 
 
Image 1 and 2. Purpuric, reddish-purple rash 

involving the lower limbs of the patient 
 

2.2 Investigations 
 
At the clinic, the patient again had some of 
investigations done for a better picture of his 
condition. Here is a summary of what was found: 
 

Chart 1. CBC Investigations 
 

CBC Normal 
Creatinine Abnormal in the earlier 

reports but had normalized. 
CRP Mildly elevated 
Serum C3 and C4 Normal levels 
Rheumatoid Factor Normal 
Other Important 
Findings 

Positive occult blood in 
stool 

 

2.3 Diagnosis and Management 
 
From the above reports, it was clear that the 
patient was suffering from abdominal angina as 
he had the classic triad of purpuric rash, 
abdominal pain, and renal involvement, all of 
which had begun after the patient had an upper 
respiratory tract infection. 
 
It was also suspected as an ideal differential that 
the patient might go on to develop Henoch 

Schonlein Purpura (IgA Vasculitis) with 
cryoglobulinemia. However, since this profile was 
not being favored due to the normal rheumatoid 
factor and C4 levels, the possibility was 
excluded. 
 
As a final resort, the patient was sent to the 
dermatology clinic for another opinion and to 
have a skin biopsy. The biopsy without 
immunofluorescence supported a diagnosis of 
IgA vasculitis and so he was treated accordingly. 
 
This biopsy led to the patient being administered 
a course of daily oral prednisolone (20 mg, PO) 
along with oral PPI for his abdominal symptoms. 
The response of the patient to steroids was 
dramatic. His rash regressed spontaneously and, 
within 48 hours of starting this treatment, the 
patient’s abdominal pain had completely resolved 
as well. 
 
After this, a skin biopsy was taken without 
immunofluorescence again, and the following 
image, used with consent, was visible at that 
time. 
 

 
 

Image 3. A skin biopsy without 
immunofluorescence 

 
There is an obvious resolution of the rash when 
compared with the patient’s earlier images. 
Immunofluorescence was not ordered for this 
patient because there was no fresh rash present 
at the time of biopsy, so it was omitted to avoid 
confusion. 
 
This is how this case was managed successfully 
in this patient with an absolute resolution of all 
the symptoms that the patient had presented with 
and had been suffering from for a long time. 



 
 
 
 

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123 

 

3. DISCUSSION 
 
The IgA present in the human body has a unique 
way of dealing with the microorganisms it 
encounters. It sometimes causes an autoreactive 
response, which can become an autoimmune- 
mediated response, resulting in the development 
of conditions such as IgA vasculitis, which is also 
known as Henoch Schonlein Purpura [5]. 
 
Bacterial and viral diseases have been seen to 
trigger IgA Vasculitis and COVID19 has also 
been seen to cause similar responses in the 
human host body. These bacteria and viruses 
are seen to elicit an autoimmune response which 
results in further insults and, finally, the 
appearance of IgA vasculitis in affected 
individuals. Some of the most well-known triggers 
that cause IgA Vasculitis include streptococcus, 
S.aureus, varicella zoster virus, human 
immunodeficiency virus (HIV), cytomegalovirus, 
and so on [6][7]. 
 
IgA vasculitis can affect both children and adults. 
In adults, it mostly takes the appearance of 
palpable purpura which are markedly present in 
the lower limbs of the patient. At times, the upper 
limbs and trunk of the patient can also be 
involved [8]. 
 
Approximately 70% of patients who suffer from 
IgA vasculitis experience abdominal pain. Of 
these, 30% also experience an episode or 
multiple episodes of gastrointestinal bleeding. 
However, this bleeding presents around a week 
after the rash has manifested on the skin of the 
patient [9]. 
 
When a patient’s kidneys become involved, 
which is an infrequent occurrence, the options for 
an appropriate medication or treatment regimen 
become narrower to avoid further damage to the 
kidneys. 
 
Almost all the affected patients have shown 
significant improvement as soon as a 
corticosteroid management plan is started. 
Prednisolone especially favors the renal profile 
without causing any further damage to the 
patient [10]. 
 
Apart from corticosteroids, the other available 
treatment options include dapsone, rituximab, 
intravenous immunoglobulin, and ACE inhibitors, 
depending on the underlying causes of the 
symptoms and the severity of the IgA vasculitis 
that the patient is suffering from. 

4. CONCLUSION 
 
IgA vasculitis, also known as Henoch Schonlein 
Purpura, is an inflammatory disease of the blood 
vessels that mostly affects children, although it 
can also occur in adults. People who suffer from 
IgA vasculitis are seen to have a raised red or 
purple rash marked predominantly on the lower 
limbs. Later in the progression of the disease, an 
affected person may develop problems of the 
gastrointestinal tract, joints, or even the renal 
system, although the severity and intensity of all 
these symptoms differ from patient to patient.  
 
This patient also developed these symptoms in a 
similar pattern – at first, he only developed an 
upper respiratory tract infection, which was 
successfully treated and therefore, not of any 
importance. Later on, he developed abdominal 
pain along with severe rash on his lower 
extremities that became the cause of his 
presenting complaints. The labs were all almost 
normal revealing no underlying disease, but later 
on, it was revealed that the patient was suffering 
from IgA vasculitis. Once diagnosed, it was 
easily managed with oral steroids and the 
condition resolve in real time, leaving behind no 
room for complications.  
 
There have been reports of recurrence of the 
disease, but since it is rare and the symptoms 
controlled, the same treatment protocol can help 
to control these flare-ups easily. 
 

CONSENT 
 
As per international standard or university 
standard, patient’s written consent has been 
collected and preserved by the author(s). 
 

ETHICAL APPROVAL 
 
As per international standard or university 
standard written ethical approval has been 
collected and preserved by the author(s). 

 
COMPETING INTERESTS 
 
Authors have declared that no competing 
interests exist. 

 
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© 2021 Ali et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License 
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, 
provided the original work is properly cited. 

 
 

 

 

Peer-review history: 
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https://www.ncbi.nlm.nih.gov/books/NBK441943/
https://www.ncbi.nlm.nih.gov/books/NBK441943/
https://www.ncbi.nlm.nih.gov/books/NBK537252/
https://www.ncbi.nlm.nih.gov/books/NBK537252/
https://doi.org/10.3390/ijms22147538
https://doi.org/10.3390/ijms22147538
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