Henoch–Schonlein purpura (HSP) is a syndrome characterized by the tetrad of cutaneous purpuric rash, arthritis, nephritis and gastrointestinal manifestations. It is a small vessel vasculitis mediated by IgA immune complex deposition in vessel walls, and is the most common systemic vasculitis encountered in the pediatric population. HSP nephritis forms part of the spectrum of IgA nephropathy (IGAN), and clinically may range from asymptomatic microscopic hematuria and/or mild proteinuria to a nephrotic syndrome and rapidly progressive crescentic renal failure. An increasing literature has reported an association between IGAN and inflammatory bowel disease (IBD). In fact, in a case series of kidney biopsies in IBD patients, IGAN proved to be the most common diagnosis.
We report a 13-year-old youth who initially presented with the typical rash of Henoch–Schonlein purpura followed a month later by a nephrotic syndrome and hematuria. Renal biopsy revealed crescentic IgA nephropathy. The patient was aggressively treated with steroids leading to a remission of his nephrotic syndrome. Three years after his initial presentation, he developed bloody diarrhea and Crohn’s disease was diagnosed.
Although gastrointestinal symptomatology may be seen in HSP patients, when prolonged the possibility of coexistent IBD should be borne in mind. In our patient, the aggressive treatment administered for his renal injury may have masked or delayed the onset of IBD.
