Henoch—Schönlein purpura in adults

A 78year-oldwomanwasadmittedtotheemergencyroomwithsevereabdominalpain.Shehad had similar episodes for several weeks, and recently developed melena. The patient’smedical history included several cardiovascular disease risk factors (type II diabetes anddyslipidemia), as well as atrial fibrillation treated by vitamin K antagonists (VKA), non-symptomatic ulcero-hemorrhagic rectocolitis, and auto-immune hemolytic anemia.The abdomen was soft with no guarding or rigidity. Otherwise, the clinical examinationwas normal. There was no melena or fever. Initial test results showed increased C-reactiveprotein (CRP) in serum and polymorphonuclear hyperleukocytosis (level: 12,000/mL).Lipases were normal and the INR was 2.2. The urine test strip revealed isolated micro-scopic hematuria with no leukocytes or nitrites. The patient was admitted for suspectedacute mesenteric ischemia.A contrast enhanced abdominopelvic CT-scan was performed to confirm the diagnosis(Fig. 1a and b). Two other abdominal CT-scans had been performed 15 and 4days beforeadmission, respectively (Fig. 2a and b).