A case of severe multifocal enteritis caused by unusual pattern of Henoch-Schonlein purpura

A 58-year-old male visited our hospital with a complaint of epigastric pain for 2 days. Physical examination showed no purpuric skin lesion. Abdominal computed tomography scan showed concentric segmental wall thickening of the duodenum. Esophagogastroduodenoscopy showed diffuse erythematous mucosa with exudates at the duodenum. On 4th hospital day, he developed hematochezia. colonoscopy showed circumferential erythematous mucosa with ulcerative hemorrhage at terminal ileum. The microscopic examination identified lots of neutrophil infiltration and deposition of immunoglobulin A (IgA) on vascular endothelium. Treatment with oral prednisone 40 mg was initiated. On 19th day, the patient developed hematuria and proteinuria. Histologic examination on renal biopsy showed focal proliferative glomerulonephritis and strongly positive IgA staining in the glomerular mesangium. Severe hemorrhagic mucosa on endoscopy, deposition of IgA on kidney and intestinal vascular endothelium suggests the diagnosis of Henoch-Schonlein purpura (HSP). We report severe multifocal enteritis caused by unusual pattern of HSP.