Can long-standing recurrent purpura truly remain benign?

Aims: To report a rare case of chronic recurrent Henoch–Schönlein purpura (IgA vasculitis) in an adult, initially benign, but complicated by delayed renal involvement, and to discuss the importance of long-term monitoring. Methods: We present the case of a 30-year-old woman with a history of recurrent purpura since adolescence. The diagnostic workup included clinical examination, laboratory investigations (renal function, proteinuria, immunological tests), and skin biopsy with direct immunofluorescence. Results: The patient presented with a flare of purpura associated with arthralgia. Despite preserved renal function and absence of systemic inflammation, significant proteinuria (1.7 g/24 h) and urinary sediment abnormalities were detected. Skin biopsy confirmed IgA vasculitis. Treatment with systemic corticosteroids and nephroprotective agents led to regression of symptoms and proteinuria. Conclusion: Chronic recurrent purpura can evolve insidiously. Biologically significant renal involvement may occur late, even without systemic inflammatory markers. Long-term urinary monitoring is essential in these patients to allow early therapeutic intervention.