Atypical Adult-Onset IgA Vasculitis With Extremely Rare Complications Including Diffuse Alveolar Hemorrhage, Heart Failure, and Stroke

IgA vasculitis (IgAV) generally occurs in young people and presents with a tetrad of symptoms: purpura, abdominal pain, arthralgia, and nephritis. However, it may have an atypical course without the typical tetrad. Diffuse alveolar hemorrhage (DAH), heart failure, and stroke are known complications of IgAV but are all very rare. We herein report a case of adult-onset IgAV that developed simultaneously with these rare complications without the typical tetrad. A 31-year-old man without any medical history presented with fever and blood-tinged sputum. Two months later, these symptoms worsened, and he was admitted to the hospital with DAH, nephritis, heart failure, and stroke. Initially, these symptoms were considered indicative of vasculitis syndrome, and he was finally diagnosed with IgAV based on the results of a renal biopsy. The treatment was successful with corticosteroids alone. IgAV should, therefore, be considered in the differential diagnosis when a patient presents with vasculitis syndrome, even with an atypical course.