IgA vasculitis, formerly known as Henoch-Schönlein Purpura (HSP), involves the inflammation of small blood vessels, primarily affecting the skin, joints, intestines, and kidneys. Although it is the most common form of vasculitis in children, it can also affect adults. Recognizing the typical presentation of IgA vasculitis is important for determining when symptoms are mild and self-limiting versus when they signal a serious complication requiring immediate medical attention. This guide focuses on signs that indicate a need for prompt hospital evaluation.
Recognizing the Common Indicators of HSP
The initial presentation of IgA vasculitis often includes a combination of three main symptoms. The most noticeable sign is palpable purpura, a distinctive, raised, reddish-purple rash that does not fade when pressed. This rash typically appears on the lower legs and buttocks, though it can also be found on the arms and trunk.
Joint involvement, or arthritis, occurs in a majority of cases, causing swelling and pain, especially in the ankles and knees. This joint pain is usually temporary and does not cause permanent damage. Mild abdominal discomfort, such as cramping, nausea, or vomiting, is also common. When these symptoms are mild, they represent the expected course of the illness and are often manageable with supportive care at home.
Emergency Signs Requiring Hospitalization
Severe organ involvement requires immediate hospitalization. The most serious potential complication involves the kidneys, manifesting as IgA vasculitis nephritis. Signs include dark, cola-colored urine, suggesting significant blood, or a marked decrease in the frequency or amount of urination. Swelling, or edema, particularly in the face or extremities, alongside these urinary changes, signals severe kidney inflammation.
A gastrointestinal crisis is another red flag. This is characterized by severe, unrelenting abdominal pain that prevents the patient from moving or speaking comfortably. Other severe signs include vomiting blood or passing bloody stool, which can indicate bleeding or a bowel obstruction. An obstruction, such as intussusception where one part of the intestine telescopes into another, is a surgical emergency often associated with IgA vasculitis.
Acute pain or swelling in the scrotum in males is a serious but less common complication requiring immediate evaluation to rule out testicular torsion. This condition is a surgical emergency that can lead to tissue damage if not promptly addressed. While rare, any sign of neurological change, such as a seizure, a sudden severe headache, or an altered mental state, warrants immediate medical attention.
When Home Care is Appropriate
Home care is appropriate when symptoms are limited to a mild rash and manageable joint pain. Since IgA vasculitis is a self-limited disease, the primary goal of home management is supportive care while the illness runs its course, usually within a few weeks.
Rest is important, and patients should maintain good hydration by drinking plenty of fluids. Pain management for joint and abdominal discomfort can typically be achieved with acetaminophen. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen should be avoided unless specifically cleared by a doctor, due to the risk of worsening potential kidney issues. Careful monitoring remains important, and any change toward emergency signs requires immediate medical consultation.