Adult-Onset IgA Vasculitis Following Keratoconjunctivitis: A Case Report

Introduction: IgA vasculitis (IgAV), previously known as Henoch-Schönlein purpura, is a small-vessel vasculitis that typically affects children and is less common in adults, where it tends to present more severely and may involve the kidneys. While preceding events such as upper respiratory infections and certain medications have been identified as potential triggers in adult IgAV, ocular infections are rarely reported. Case Description: We report the case of a 27-year-old woman with no significant past medical history who developed arthralgia of the hands and knees, abdominal pain, and ascending palpable purpura over a three-week period. Laboratory studies revealed low-grade proteinuria, microscopic hematuria, and a skin biopsy confirmed IgAV. One month prior to symptom onset, the patient had been diagnosed with herpetic keratoconjunctivitis in the right eye. She was treated with colchicine and a tapered course of oral prednisone, leading to full resolution of symptoms within two months. Discussion: Due to limited evidence specific to adult IgAV, management recommendations often follow those for IgA nephropathy (IgAN). Renin-angiotensin system blockade is advised when proteinuria exceeds 0.5 grams per day. Immunosuppressive therapy for IgAV nephritis is typically reserved for patients with marked proteinuria (>1 g/day), impaired kidney function, or rapidly progressive glomerulonephritis during the acute phase. Outside of these indications, the use of glucocorticoids for other IgAV symptoms remains controversial. This case adds to the literature on adult-onset IgAV by highlighting a potential association with an uncommon preceding infection—herpetic keratoconjunctivitis. While glucocorticoids may offer more rapid symptomatic improvement, their impact on long-term clinical outcomes, including persistent kidney disease, remains uncertain.