Morning report 9/18, IgA vasculitis

Interesting morning report today about IgA vasculitis secondary to MRSA bacteremia. This is a nice review about IgA vasculitis:

https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/hospital-medicine/henoch-schonlein-purpura-iga-vasculitis/

some interesting points:

  • classic tetrad of HSP – GI symptoms / abdominal pain, histopathylogy, arthralgias and renal involvement.
  • In adults renal involvement more severe than in children and more end up needing RRT.
  • In adults purpura very prevalent (close to 100% of cases).
  • “Adults more commonly have been observed to have upper extremity purpura than children” – not sure how much this is based on literature, but bottom line is that the rash is gravity dependent, so tends to occur in lower extremities and distally but can also occur in upper extremities

 

These are two articles about post-staphylococcal infection HSP nephritis (PSI-HSPN) also called Staphylococcus-associated glomerulonephritis (SAGN). Bottom line is that it is a type of post-infectious GN, with 3 keys differences:

  • The classic PIGN is post strep (throat or skin usually) and this is associated with staph
  • Deposition is of C3 and IgA as compared to IgG and C3 or only C3 in classic post-strep
  • This is more of a synpharyngitic picture, or syn-bacteremic as in our patient. This is similar to IgAN which is usually a few days (1-3) after URTI in children and opposed to classic PIGN which is usually 2-4 weeks after the strep infection

https://www.tandfonline.com/doi/full/10.3109/0886022X.2013.794703

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5985547/

AS

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