-Case Reports-

IgA Vasculitis Complicated by Cytomegalovirus Enteritis: A Case Report

Risa Ninomiya, Tokuya Omi, Tokue Kato, Nobuko Mayumi, Mai Kawarasaki and Seiji Kawana

Department of Dermatology, Nippon Medical School

A 61-year-old man was admitted to our department with purpura and hemorrhagic bullae on his lower limbs, dull pain affecting the entire abdomen, and hematochezia. Histopathological examination and immunostaining revealed leukocytoclastic vasculitis of the small blood vessels of the dermis and IgA deposition; multiple ulcers were observed in the ileum during lower gastrointestinal (GI) endoscopy, so we made a diagnosis of IgA vasculitis (Henoch-Schönlein). Treatment with oral prednisolone (PSL) at a dose of 80 mg/day (1 mg/kg/day) for one week resolved the symptoms almost completely. However, when the PSL dose was later reduced, dull epigastric pain and discomfort flared up again. Multiple punched-out ulcers were observed in the duodenum during upper GI endoscopy, and immunostaining revealed cytomegalovirus (CMV) in vascular endothelial cells and infiltrating cells. The patient's serum was positive for CMV antigenemia. On the basis of these findings, we concluded that the CMV enteritis had developed as a complication arising from the patient's immunosuppressed state, which was itself a result of the steroid therapy. We treated the patient with ganciclovir, which relieved the abdominal symptoms.

J Nippon Med Sch 2014; 81: 48-52

Keywords
IgA vasculitis, cytomegalovirus enteritis, corticosteroid therapy, immunosuppression

Correspondence to
Seiji Kawana, MD, PhD, Department of Dermatology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
kawa2559@nms.ac.jp

Received, September 20, 2013
Accepted, October 11, 2013