PMC7243385_01
Palpable purpura with convalescence and necrosis on (A) bilateral palmar hands, (B) bilateral dorsal hands, (C) bilateral lower extremities, and (D) chest and abdomen. There is edema and inflammation as well as extravasation of blood from damaged blood vessels in association with immunoglobulin A vasculitis (Henoch-Schonlein purpura).
10.1177_2324709620925565-fig1.jpg
PMC7243385_01_10.1177_2324709620925565-fig1.jpg
fig1-2324709620925565
Physical examination was notable for palpable purpuric lesions distributed extensively across the lower extremities, abdomen, and back (Figure 1A-D).
(A) Light microscopy with hematoxylin and eosin (H&E) stain highlights diffuse proliferative glomerulonephritis with inflammatory changes in glomeruli, including mesangial hypercellularity (ovals). (B) Direct immunofluorescence microscopy with staining shows granular IgA deposition in peripheral and mesangial capillary walls. (C) Light microscopy with H&E stain displays vessel wall fibrinoid necrosis (arrow) surrounded by focal capillary loop rupture.
10.1177_2324709620925565-fig2.jpg
PMC7243385_01_10.1177_2324709620925565-fig2.jpg
fig2-2324709620925565
Light microscopy demonstrated diffuse proliferative changes with endocapillary hypercellularity, infiltration of polymorphonuclear neutrophils within capillary loops, and segmental fibrinoid necrosis (Figure 2A, C). On immunofluorescence, there was granular staining of the glomeruli with IgA, C3, and Lambda light chains consistent with diffuse proliferative and exudative glomerulonephritis with IgA dominant immune complex deposits (Figure 2B).
Axial view of CT scan of the abdomen pelvis displays extensive bowel pneumatosis (arrows).
10.1177_2324709620925565-fig3.jpg
PMC7243385_01_10.1177_2324709620925565-fig3.jpg
fig3-2324709620925565
A computed tomography (CT) scan of the abdomen was performed and showed extensive pneumatosis of the gut wall consistent with bowel ischemia (Figure 3).
On postoperative day 6, the open abdominal wound measures 20 cm x 15 cm x 10 cm in the left lower quadrant. The opening of the wound is oval, dusky, and oozing. There are ulcerations in the surrounding skin.
10.1177_2324709620925565-fig4.jpg
PMC7243385_01_10.1177_2324709620925565-fig4.jpg
fig4-2324709620925565
The wound was large and widely open involving the entire thickness of the muscles of the anterior abdominal wall (Figure 4).