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Abdominal pain in pediatric immunoglobulin A vasculitis: Risk factors and severity predictors in a multicenter cohort

Francisco Hugo Rodrigues Gomes1, Natalia Maronese1, Leticia Lizardo Magalhaes1

  • 1Division of Pediatric Rheumatology, Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.

Journal of Pediatric Gastroenterology and Nutrition
|July 1, 2026
PubMed

Insights

In pediatric immunoglobulin A vasculitis (IgAV), prolonged rash and high white blood cell count are linked to severe abdominal pain. Leukocytosis can predict acute abdomen in children with IgAV.

Area of Science:

  • Pediatric Rheumatology
  • Vasculitis Research
  • Gastrointestinal Manifestations in Children

Background:

  • Abdominal pain is a common complication in pediatric immunoglobulin A vasculitis (IgAV).
  • Identifying risk factors for severe abdominal pain and its complications is crucial for timely intervention.
  • Predicting which children with IgAV are at higher risk for complicated abdominal pain remains a clinical challenge.

Purpose of the Study:

  • To determine risk factors for abdominal pain in pediatric IgAV patients.
  • To identify predictors of complicated abdominal pain, including intussusception, intestinal bleeding, or acute abdomen.
  • To evaluate the association of clinical factors with abdominal pain outcomes in IgAV.

Main Methods:

  • Retrospective multicenter study of pediatric IgAV patients (≤18 years) meeting EULAR/PRINTO/PRES criteria.
  • Analysis of factors associated with abdominal pain and complicated abdominal pain within the first 3 months and at the end of follow-up.
  • Utilized univariate analyses, multivariable log-binomial regression, and receiver operating characteristic (ROC) curve analysis.

Main Results:

  • 61.1% of 687 pediatric IgAV patients experienced abdominal pain within 3 months; 22.2% of those with pain developed complications.
  • Prolonged purpuric/petechial rash (>29 days) and leukocytosis (>13,500/mm³ ) were independently associated with complicated abdominal pain.
  • Leukocytosis demonstrated strong discriminatory performance for predicting acute abdomen (AUC 0.813).

Conclusions:

  • Prolonged purpuric/petechial rash and leukocytosis are significant independent predictors of complicated abdominal pain in pediatric IgAV.
  • Leukocytosis serves as a valuable clinical marker to identify children with IgAV at increased risk for developing acute abdomen.
  • Early identification of these risk factors can guide management strategies for pediatric IgAV patients presenting with abdominal pain.
Abstract

Keywords:
Henoch–Schonlein purpuraabdomen, acutegastrointestinal diseasesintussusceptionleukocytosis

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