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Terminal ileitis: a rare gastrointestinal manifestation of IgA vasculitis in a child
Kirn Sandhu1, Kirsteen Mcdonald2, Louise Langmead3
1Paediatric Gastroenterology, Barts Health NHS Trust, London, UK kirnsandhu@gmail.com.
Insights
Henoch-Schonlein purpura can cause terminal ileitis, a rare but treatable small bowel inflammation. Early diagnosis and steroid treatment led to a full recovery, avoiding surgery in this pediatric case.
Area of Science:
- Pediatric Surgery
- Pediatric Gastroenterology
- Immunology
Background:
- A middle childhood girl presented with acute abdominal pain and vomiting, initially suspected to be inflammatory bowel disease.
- Investigations revealed elevated inflammatory markers and small bowel thickening on imaging.
Observation:
- Endoscopy showed gastritis and duodenitis, while colonoscopy was normal.
- Video capsule endoscopy identified jejunal and ileal ulcers.
- A symmetrical purpuric rash on the ankles led to the diagnosis of Henoch-Schonlein-related ileitis.
Findings:
- Terminal ileitis is a rare complication of IgA vasculitis (Henoch-Schonlein purpura).
- Video capsule endoscopy is valuable for visualizing small bowel pathology.
- Multidisciplinary management, including methylprednisolone and oral steroids, was effective.
Implications:
- This case highlights the importance of considering IgA vasculitis in pediatric patients with unexplained ileitis.
- Prompt diagnosis and non-surgical management of Henoch-Schonlein-related ileitis lead to favorable outcomes.
- Early recognition and treatment can prevent surgical intervention for this rare condition.
Abstract:
A girl in middle childhood was referred to the paediatric surgical team with acute colicky abdominal pain and bile-stained vomiting. This was preceded by a viral illness. Investigations revealed raised inflammatory markers, and imaging of the abdomen demonstrated ileal and jejunal thickening. Concerns were raised regarding whether she had inflammatory bowel disease. Endoscopy revealed gastritis and duodenitis, and colonoscopy was unremarkable. Video capsule endoscopy demonstrated ulcers in the jejunum and ileum.On day 8 of admission, she developed a symmetrical purpuric rash over both ankles leading to the diagnosis of Henoch-Schonlein-related ileitis. Multidisciplinary team working led to appropriate management of the patient and avoided surgery. Video capsule endoscopy enabled visualisation of the small bowel. She was managed with 5 days of methylprednisolone followed by oral steroids. She made a good recovery with no sequelae. This case highlighted that terminal ileitis is a rare complication of IgA vasculitis with a good prognosis.
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