Intramuscular Hematoma as a Manifestation of IgA Vasculitis

Abstract

We describe an atypical pediatric case of immunoglobulin A vasculitis (IgAV), also referred to as Henoch-Schönlein purpura, in which formation of spontaneous hematoma of the paraspinal muscles developed. Spontaneous or unprovoked hematomas rarely occur in IgAV. These manifestations have not been described specifically in the pediatric literature as coinciding with IgAV. These findings are alarming for nonaccidental trauma, particularly in a patient without underlying blood dyscrasia. Our objective for this report is to highlight the possible association of muscular hematoma formation with IgAV and to help providers consider this association when trauma and hemophilia has been ruled out.

Immunoglobulin‐A vasculitis manifesting as edema in the scalp, face, and sternocleidomastoid muscle

“…Intramuscular vessel injury and inflammatory cell infiltration may lead to intramuscular hemorrhage or myositis in IgAV, as observed in previous reports. [5][6][7][8] Enlargement of the muscle with heterogeneous marked echogenicity or increased echogenicity has been reported to indicate muscle edema, which was confirmed by magnetic resonance imaging (MRI). 12,13 In our case, muscle edema may reflect an early stage of myositis, although the serum creatinine kinase level was not elevated.…”

“…Muscle is rarely involved in patients with IgAV, and only four cases with muscle involvement recognized by imaging tests or biopsy have been reported (Table 1). [5][6][7][8] Among them, three cases involved the lower extremities, and one involved the paraspinal muscle. Imaging tests revealed intramuscular hematoma in two cases, myositis in one case, and both intramuscular hematoma and myositis in one case.…”

“…Muscle involvement in IgAV is an uncommon symptom and typically occurs in the lower extremities. [5][6][7][8] We herein report an adult patient with IgAV presenting with edema in the face, scalp, and sternocleidomastoid muscle.…”