a 62-year - old female with known hyperlipidemia developed acute purpuric rashes over her lower limbs and abdomen 3 weeks after consuming ibuprofen for her right shoulder pain . she was seen by a dermatologist for the rash who diagnosed hsp [ figure 1 ] . she did not take any other medication or supplement apart from five tablets of 200 mg ibuprofen over 5 days period . four weeks later , she developed new onset of leg edema , frothy urine , and hypertension . schnlein purpura in lower limbs ( side view ) laboratory test results were as follows : urea : 3 mmol / l , creatinine : 83 mol / l , hemoglobin : 11.4 g / dl , white blood cell : 10.1  10 platelet : 344  10 , albumin : 26 g / l , total cholesterol : 5.64 mmol / l , triglyceride : 2.61 mmol / l , low - density lipoprotein : 3.05 mmol / l , and erythrocyte sedimentation rate : 116 mm / h . urinalysis revealed red blood cell : 4 + , protein : 4 + with 24 h urine protein of 1.8 g. serum complements ( c3 and c4 ) were normal . p - anti neutrophil cytoplasmic antibody ( anca ) , c - anti anca , antinuclear antibody , and anti - double stranded dna antibody were negative . serum immunoglobulin showed markedly elevated serum ige level at 2077 ku / l ( normal , renal biopsy revealed changes consistent with either iga nephropathy or hsp nephritis with 34% active cellular crescents and sclerosing pattern with 13% global glomerulosclerosis . there was also tubulointerstitial inflammation with acute tubular necrosis - like changes and mild chronic tubulointerstitial damage . the pathogenesis of hsp remains unclear , but it is generally considered to be an immune complex - mediated disease characterized by the tissue deposition of polymeric iga1-containing immune complexes . the pathognomonic granular iga and c3 deposits in the mesangium are indistinguishable from those seen in iga nephropathy . however , the presence of characteristic skin lesion , an elevated serum ige level , and the presence of crescents in histopathology favor hsp over iga nephropathy . hsp usually affected patient younger than 10 years old with a 2:1 male preponderance . in one series , hsp was the most common cause of crescentic glomerulonephritis in children . triggers for hsp include upper respiratory infection , neoplastic disease such as leukemia , and myelodysplastic disorder and medications such as captopril , diclofenac , and vancomycin . in this case , we believe that the episode is likely triggered by ibuprofen consumption which has never been reported before . the patient has not consumed any other supplement or medications apart from ibuprofen . in this case , according to the objective causality assessment by the naranjo adverse drug reaction probability scale , the causal association between ibuprofen and the adverse event was probable ( naranjo score = 6 ) . the adverse drug reaction was evaluated for causality assessment using the world health organization - uppsala monitoring center ( who - umc ) criteria . the assigned causality category with who - umc criteria for this adverse drug reaction was  certain . as mentioned earlier , hsp nephritis is associated with high ige level which may be attributed by immunoallergic response to external stimuli . although the average natural course of the disease is 1 month with good recovery , there are cases that have a protracted course that may end up as end - stage renal failure . management is controversial and ranges from conservative to the addition of steroids to various immunosuppressants such as azathioprine , plasmapheresis , and cyclophosphamide . in this case , since there is the presence of abundance of crescents which usually denotes a more aggressive disease progression , we decided to use oral azathioprine at a dose of 2 mg / kg and full dose oral prednisolone at 1 mg / kg as the preferred first - line immunosuppressants therapy . the presence of tubulointerstitial inflammation , fibrosis , and glomerulosclerosis in this patient was also independent risk factors for renal function decline in various renal models . we believe that these immunosuppressants together with angiotensin - converting enzyme inhibitor have a role in preventing the fibrotic transformation of the lesion . ibuprofen - induced hsp nephritis has to be suspected when there is the presence of nephritic - nephrotic syndrome together with the classical skin rash over the extensor surfaces . prompt diagnosis , withdrawal of the offending drug , and instituting the correct immunosuppressant are key to prevent the possible deterioration of the renal function there are no conflicts of interest .
ibuprofen is a nonsteroidal anti - inflammatory drug that is used widely in treating pain , fever , and inflammation . 
 its side effects are mainly due to acute renal impairment and gastric discomfort . 
 we hereby report a rare case of henoch  schnlein purpura nephritis secondary to ibuprofen consumption which has not been reported in literature before .