Mucosal Fibrosis on Biopsy Predicting Intestinal Perforation in Adult-Onset IgA Vasculitis: A Case Report

TL;DR

A biopsy showing mucosal fibrosis in adult-onset IgA vasculitis may predict intestinal perforation, suggesting the need for early aggressive treatment.

Contribution

The case highlights mucosal fibrosis as a potential early predictor of intestinal perforation in IgA vasculitis.

Findings

A biopsy showed localized fibrosis before treatment, while surgery revealed ulceration and perforation.

Extensive submucosal fibrosis was observed at the same site during surgical pathology.

The findings suggest fibrotic changes may indicate a risk of perforation and the need for early cyclophosphamide.

Abstract

We report a case of adult-onset IgA vasculitis that required surgery due to the perforation of the jejunum despite treatment with high-dose glucocorticoids and resolution of the inflammatory response. A mucosal biopsy before treatment revealed only localized fibrosis, while surgical pathology demonstrated ulceration and perforation with extensive submucosal fibrosis at the same site. These findings suggest that mucosal fibrotic changes observed on biopsy may indicate a risk of perforation and support the early use of cyclophosphamide or other agents for refractory disease.

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