title: An unusual presentation of childhood vasculitis presenting in adulthood: a challenging diagnosis of henoch-schönlein purpura.
abstract: BACKGROUND
  Henoch-Schönlein purpura (HSP), a systemic IgA vascultitis, is uncommon in adults, with an incidence rate of 0.1 to 1.2 per million in adults over 20 years old. This vasculitic syndrome can present as an uncommon cause of intestinal obstruction in older patients. We report a case of an older woman with HSP presenting with small bowel obstruction and vasculitic rash.
  
  
  METHODS
  We report a 67-year-old woman who presented with small bowel obstruction and skin rash. Skin biopsy revealed leukocytoclastic vasculitis with +IgA granular deposition within the walls of superficial dermal vessels. Kidney biopsy confirmed the diagnosis of HSP with mild mesangial proliferative IgA nephropathy. Her abdominal pain and small bowel obstruction were improved with conservative treatment. She continued to do well with normal kidney function at a 3-month follow-up visit.
  
  
  CONCLUSIONS
  HSP, a systemic IgA vasculitis, is a predominantly pediatric vasculitis and is uncommon in adults. In adults, the disease process is identical to that in children. However, gastrointestinal manifestation is less common in older patients, and bowel perforation and obstruction are rare. Intestinal obstruction with skin rash and renal involvement should raise suspicions of HSP.
authors.affiliation: Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Charat
authors.initials: C
authors.lastname: Thongprayoon
authors.affiliation: Mayo Clinic, Rochester, Minnesota, USA ; Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Wisit
authors.initials: W
authors.lastname: Cheungpasitporn
authors.affiliation: Bassett Medical Center, Cooperstown, New York, USA.
authors.forename: Natanong
authors.initials: N
authors.lastname: Thamcharoen
authors.affiliation: Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Jackrapong
authors.initials: J
authors.lastname: Bruminhent
keywords: Henoch-Schönlein purpura; Intestinal obstruction; Vasculitis