Rare Adult Case of IgA Vasculitis in Nepal Mimics Chronic Stomach Issues for a Year
The South Asian Pattern: Key Insights
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GI-First Presentation: In approximately 14% of adult cases globally, gastrointestinal symptoms precede the rash. In South Asian case reports, this often leads to patients being treated with antibiotics for “suspected infection” first, which may temporarily mask the underlying vasculitis.
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Surgical Mimicry: Atypical cases in the region have led to unnecessary surgeries. One reported case saw an adult male undergo an exploratory laparotomy for suspected bowel obstruction, only for surgeons to find “beefy-red” vasculitic changes instead of a mechanical blockage.
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Resource Constraints: Similar to the Nepal case, many reports from Bangladesh and India emphasize the reliance on clinical criteria over the “gold standard” biopsy due to the high cost and limited availability of immunofluorescence facilities.
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Renal Severity: Adult-onset IgAV in South Asia tends to have a higher rate of renal involvement (40–85%) compared to pediatric cases, with a greater risk of progressing to chronic kidney disease if not treated early.