Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc
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Case Report

Volume 13, Number 4, April 2022, pages 145-150

An Immunoglobulin A Vasculitis Case Without Skin Symptoms Complicated With Severe Abdominal Symptoms


Figure 1.
Figure 1. Findings on an abdominal roentgenography, an ultrasonography, and a contrast computed tomography at disease onset. At disease onset, roentgenography revealed a gasless abdomen and an image of a partially enlarged colon (a). Abdominal ultrasonography and enhanced computed tomography showed images of the thickened wall of the small intestine (b, c, white arrow).
Figure 2.
Figure 2. Clinical course in relation to laboratory findings. The horizontal axis shows days after the patient’s admission, and the left vertical axis shows the patient’s serum levels of CRP and Alb. The right vertical axis shows the levels of D-dimer and the quantitative value of stool OB. The upper row shows the transition of FXIII activity and treatment content. The polygonal lines show the transition of the inspection values. CRP: C-reactive protein; Alb: serum albumin; %FXIII: coagulation factor XIII activity; stool OB: stool occult blood; FOM: fosfomycin; PSL: prednisolone; mPSL: methylprednisolone; DDS: diaminodiphenyl sulfone; HD: hospital days.


Table 1. Laboratory Findings on Admission
WBC: white blood cell; RBC: red blood cell; Hb: hemoglobin; PLT: platelets; AST: aspartate transaminase; ALT: alanine transaminase; LDH: lactate dehydrogenase; T-Bil.: total bilirubin; TP: total protein; Alb: albumin; BUN: blood urea nitrogen; Cre: creatinine; Na: natrium, K: potassium; Cl: chloride; CRP: C-reactive protein; PT-INR: prothrombin time-international normalized ratio; aPTT: activated partial thromboplastin time; %FXIII: factor XIII activity; Ig: immunoglobulin; ANA: anti-nuclear antibody; CH50: total hemolytic complement; DNA: deoxyribonucleic acid; CL: cardiolipin; CMV: cytomegalovirus; ELISA: enzyme-linked immuno sorbent assay; Neg: Negative.
WBC24,930/µLPT-INR1.10pH (urinalysis)7.5
RBC523 × 104/µLaPTT28.9 sRed blood cell (urinalysis)Neg
Hb15.2 g/dLD-dimer21.2 µg/mLWhite blood cell (urinalysis)Neg
PLT20.3 × 104/µLProtein (urinalysis)Neg
AST51 IU/LOccult blood (stool)(+)
ALT58 IU/LIgG640.5 mg/dL334 ng/mL
LDH230 IU/LIgA82.7 mg/dL
T-Bil.0.2 mg/dLIgM64.1 mg/dLStool (culture)Normal flora
TP5.6 g/dLANA< 40 (1:n)Blood (culture)Neg
Alb2.9 g/dLCH5048.6 U/mL
BUN11.8 mg/dLC3103.6 mg/dL
Cre0.37 mg/dLC430.6 mg/dL
Na137 mEq/LAnti-DNA antibody< 2.0 IU/mL
K4.0 mEq/LAnti-CL antibody< 8.0 IU/mL
Cl98 mEq/L
CRP5.91 mg/dLCMV IgG (ELISA)< 2.0
CMV IgM (ELISA)0.29 mg/dL