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Terminal ileitis: a rare gastrointestinal manifestation of IgA vasculitis in a child
  1. Kirn Sandhu1,
  2. Kirsteen Mcdonald2,
  3. Louise Langmead3 and
  4. Protima Deb1
  1. 1 Paediatric Gastroenterology, Barts Health NHS Trust, London, UK
  2. 2 Paediatric Radiology, Barts Health NHS Trust, London, UK
  3. 3 Adult Gastroenterology, Barts Health NHS Trust, London, UK
  1. Correspondence to Dr Kirn Sandhu; kirnsandhu{at}gmail.com

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.

  • Paediatrics
  • Endoscopy
  • Crohn's disease
  • Vasculitis
  • Radiology

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Footnotes

  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: KS, PD, KM, LL. The following authors gave final approval of the manuscript: KS, PD, LL, KM.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.