J Med Cases

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

Journal website https://www.journalmc.org

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. 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. 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.
WBC	24,930/µL	PT-INR	1.10	pH (urinalysis)	7.5
RBC	523 × 10⁴/µL	aPTT	28.9 s	Red blood cell (urinalysis)	Neg
Hb	15.2 g/dL	D-dimer	21.2 µg/mL	White blood cell (urinalysis)	Neg
PLT	20.3 × 10⁴/µL			Protein (urinalysis)	Neg
		%FXIII	32%
AST	51 IU/L			Occult blood (stool)	(+)
ALT	58 IU/L	IgG	640.5 mg/dL		334 ng/mL
LDH	230 IU/L	IgA	82.7 mg/dL
T-Bil.	0.2 mg/dL	IgM	64.1 mg/dL	Stool (culture)	Normal flora
TP	5.6 g/dL	ANA	< 40 (1:n)	Blood (culture)	Neg
Alb	2.9 g/dL	CH50	48.6 U/mL
BUN	11.8 mg/dL	C3	103.6 mg/dL
Cre	0.37 mg/dL	C4	30.6 mg/dL
Na	137 mEq/L	Anti-DNA antibody	< 2.0 IU/mL
K	4.0 mEq/L	Anti-CL antibody	< 8.0 IU/mL
Cl	98 mEq/L
CRP	5.91 mg/dL	CMV IgG (ELISA)	< 2.0
		CMV IgM (ELISA)	0.29 mg/dL

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.

WBC

24,930/µL

PT-INR

1.10

pH (urinalysis)

7.5

RBC

523 × 10⁴/µL

aPTT

28.9 s

Red blood cell (urinalysis)

Neg

15.2 g/dL

D-dimer

21.2 µg/mL

White blood cell (urinalysis)

Neg

PLT

20.3 × 10⁴/µL

Protein (urinalysis)

Neg

%FXIII

32%

AST

51 IU/L

Occult blood (stool)

(+)

ALT

58 IU/L

IgG

640.5 mg/dL

334 ng/mL

LDH

230 IU/L

IgA

82.7 mg/dL

T-Bil.

0.2 mg/dL

IgM

64.1 mg/dL

Stool (culture)

Normal flora

5.6 g/dL

ANA

< 40 (1:n)

Blood (culture)

Neg

Alb

2.9 g/dL

CH50

48.6 U/mL

BUN

11.8 mg/dL

103.6 mg/dL

Cre

0.37 mg/dL

30.6 mg/dL

137 mEq/L

Anti-DNA antibody

< 2.0 IU/mL

4.0 mEq/L

Anti-CL antibody

< 8.0 IU/mL

98 mEq/L

CRP

5.91 mg/dL

CMV IgG (ELISA)

< 2.0

CMV IgM (ELISA)

0.29 mg/dL