Low Back Pain and Swelling as an Atypical Presentation of IgA Vasculitis

Abstract

Introduction: Immunoglobulin A vasculitis (IgA vasculitis), formerly Henoch-Schonlein purpura, is the most common vasculitis in children. Case Report: A 6-year-old female presented with low back pain and swelling, difficulty ambulating, and rash two weeks after a respiratory infection. She was approached with a broad differential and ultimately diagnosed with IgA vasculitis. Discussion: Cutaneous manifestations, arthralgias, renal and gastrointestinal involvement are the most common presenting signs of IgA vasculitis. Only two cases of IgA vasculitis associated with lumbar pain and swelling were identified in the literature. Conclusion: While rash and joint pain are common presenting signs of IgA vasculitis, practitioners should be aware it can present atypically.

Lumbosacral Edema as an Unusual Presentation of Henoch-Schönlein purpura: A Case Report and Literature Review

“…These features met with the diagnostic criteria proposed by the European Leagu Against Rheumatism (EULAR) / Paediatric Rheumatology European Society (PReS) / Paediatric Rhumatology International Trials Organisation (PRINTO). 7,8 Our case shows that HSP should be considered a broad differential diagnosis in patients with atraumatic lower back pain, swelling, and refusal to walk. This case also highlights the importance of careful physical examination for HSP diagnosis.…”

“…To our knowledge, only five cases of HSP with lumbar edema have been reported (Table 1). [3][4][5][6][7] Consistent symptoms associated with lumbosacral edema were acute -onset severe back pain and refusal to walk. Back pain was the initial symptom of HSP reported on first to second day of illness, except for one patient.…”

“…Back pain was the initial symptom of HSP reported on first to second day of illness, except for one patient. [3][4][5][6][7] Interestingly, most of these patients whose back pain was an initial symptom were admitted to the hospital via ED, 3,7 probably because the back pain was sudden and severe. Our patient also had arthralgia in ankles and knees the day before, but he visited the ED for subsequent sudden back pain.…”

“…However, the diagnosis seemed relatively straightforward in most cases because of concomitant purpura and / or arthralgia. 3,6,7 Meanwhile, it could be challenging to diagnose HSP when purpura is accompanied by lumbosacral edema alone without other joint symptoms or abdominal pain. Shimizu et al mentioned that they hesitated to diagnose HSP in a seven year old girl with lumbosacral edema with acute-onset severe left low back with severe tenderness.…”

“…2 Subcutaneous edema of the lumbosacral area has been recently reported as an infrequent presentation of HSP. [3][4][5][6][7] This unusual presentation of HSP needs to be well aware because it manifests as acute and severe backache, a symptom that could puzzle physicians. Here, we report a case of HSP with lumbosacral edema that led to concern about the serious condition of the spinal cord.…”