Pulmonary-Cardiac Involvement in a Patient with IgA Vasculitis.
Malak Almutlaq, Hamad Alhumaidan, Mohannad K Maghrabi et al.
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Case in brief
A 41-year-old woman with biopsy-proven IgA nephropathy presented with progressive dyspnea, hemoptysis, and a painful purpuric rash. Evaluation showed severe multisystem IgA vasculitis, with leukocytoclastic vasculitis on skin biopsy and diffuse alveolar hemorrhage on bronchoscopy. Cardiac magnetic resonance imaging demonstrated an ejection fraction of 25%, diffuse mid-wall and epicardial enhancement with abnormal T1 and T2 values, and a 25 × 15 mm apical thrombus. Imaging and serologic testing helped exclude cardiac sarcoidosis, ANCA-associated vasculitis, and anti-glomerular basement membrane disease. After immunosuppressive treatment, plasma exchange, and cautious anticoagulation, hemorrhage resolved, biomarkers declined, the thrombus resolved, and systolic function partially recovered.
What made this case unusual
The case combined pulmonary hemorrhage with severe cardiac involvement, including marked left ventricular dysfunction and an apical thrombus, in adult IgA vasculitis.
Diagnostic / clinical pearl
In multisystem IgA vasculitis with cardiopulmonary symptoms, cardiac magnetic resonance imaging can characterize myocardial involvement and detect intracardiac thrombus; integrate imaging with tissue findings and serologic testing to assess competing diagnoses.
Why it matters
The report adds to the limited characterization of cardiac involvement in adult IgA vasculitis and illustrates the role of multidisciplinary assessment in diagnosis and management.