Delayed presentation with henoch–schönlein purpura in a patient with immunoglobulin a nephropathy

Henoch–Schonlein purpura (HSP) nephritis (HSPN) and immunoglobulin A (IgA) nephropathy (IgAN) are related conditions that may be encountered sequentially in the same patient, are described in twins, and have common biological and pathological basis. The clinical features as well as the spectrum of severity at presentation vary significantly among patients. Here, we report a girl who first presented with acute glomerulonephritis and biopsy evidence of acute diffuse proliferative IgA nephritis with crescents, and 5 years later, she developed HSP and proteinuria. Such delayed appearance of cutaneous manifestations after initial renal involvement is unusual, though reported previously. This presentation stresses the importance of long-term follow-up of patients with HSPN and primary IgAN.