First case of IgA vasculitis atypically presenting as recurrent gastroenteritis from Nepal: a case report and review of the literature.

Introduction and importance: Immunoglobulin A vasculitis (IgAV), though primarily a childhood disease, is uncommon in adults and often presents atypically, leading to diagnostic delays. We report the first known case of adult-onset IgAV from Nepal, presenting as recurrent episodes of acute gastroenteritis. The delayed appearance of purpuric rash - nearly a year after symptom onset - and the rapid response to oral corticosteroids make this case unique and thus add to the existing literature on adult IgAV. Case presentation: A 57-year-old male presented with 4 days of purpuric rash, abdominal pain, and loose stools. He reported five similar gastroenteritis-like episodes over the prior year, resolving temporarily with antibiotics. Examination revealed palpable purpuric lesions on limbs and trunk. IgAV was diagnosed clinically per EULAR/PRINTO/PRES criteria. Oral prednisolone (60 mg/day) with gastric protection led to complete symptom resolution within 1 week. Antibiotics were discontinued after negative stool cultures. Steroids were tapered over 2 months without relapse. Clinical Discussion: IgAV presents with purpura, abdominal pain, arthralgia, and renal involvement. Diagnosis is often delayed in adults due to atypical symptoms and the absence of rash. Early corticosteroid therapy is effective even without biopsy confirmation in resource-constrained settings. This case underscores the importance of considering IgAV in recurrent gastrointestinal complaints and highlights the effectiveness of corticosteroids, emphasizing the need for clinical vigilance. Conclusion: IgAV should be considered in adults with unexplained recurrent abdominal pain. Early recognition of the condition, even before the skin manifestations, can significantly improve the prognosis and patient outcome.