Cardiac Vasculitis in Henoch-Schonlein Purpura

Abstract

A 63-year-old man presented with a 1-week history of bloody diarrhea, abdominal pain, nausea, arthralgias, and fatigue. Physical examination revealed an acutely ill patient with a distended, tender abdomen. A purpuric skin rash was noted on the extremities and trunk (Figure Laboratory tests showed leukocytosis, proteinuria, and elevated creatinine. A skin biopsy revealed small-vessel neutrophilic vasculitis. Immunofluorescence was positive for multifocal IgA deposits along the walls of dermal vessels (Figure High-dose prednisone and azathioprine were started. On hospital day 4, the patient developed slow junctional rhythm with hypotension requiring transvenous ventricular pacing. Serum cardiac troponin T was elevated. Sinus rhythm never recovered, and ectopic low atrial