Imaging and laboratory findings of adult abdominal IgAV stratified by the onset sequence of cutaneous and gastrointestinal symptoms: a retrospective case series

Objectives To describe Computed Tomography (CT) and laboratory findings in adult cases of abdominal immunoglobulin A vasculitis (IgAV), comparing patients who experienced cutaneous purpura before versus after gastrointestinal (GI) symptoms. Methods We retrospectively studied eight adults (median age, 66 years; range, 18–83; 7 males) diagnosed with abdominal IgAV at our hospital (2020–2025). All underwent abdominal CT and were grouped as rash-first (n=5) or abdominal-first (n=3). Results All eight patients showed bowel wall thickening; seven had the target sign, and six had peritoneal effusion. The ileum (6/8) and jejunum (5/8) were most frequently involved. C-reactive protein (CRP) was elevated in seven patients; the neutrophil-to-lymphocyte ratio (NLR) and D-dimer were elevated in all eight. All patients’ abdominal symptoms improved before discharge; purpura improved or resolved in seven, and the subsequent purpura in Case 3 resolved after outside-hospital treatment. The abdominal-first group had a higher median D-dimer (7.11 vs. 4.96 µ g/mL; range, 4.70–22.39 vs. 2.50–8.34), and segmental involvement was seen in 2/3 abdominal-first versus 1/5 rash-first patients. Conclusion Wall thickening and the target sign were the primary CT findings, predominantly in the jejunoileal region. A descriptive trend toward segmental involvement was observed in patients with abdominal pain preceding purpura (2/3 vs. 1/5), whereas elevated D-dimer and the target sign were near-universal regardless of onset sequence and thus not subgroup-specific. These combined CT and laboratory features may suggest abdominal IgAV in acute abdominal pain, especially when purpura appears subsequently or concurrently. Larger prospective studies are needed to validate these findings.