CASE REPORT: HEMORRHAGIC VASCULITIS IN AN ELDERLY PATIENT

Abstract

Introduction. Hemorrhagic vasculitis (HV), or Schönlein–Henoch purpura, is a systemic vasculitis of small vessels, predominantly mediated by IgA. Although the disease occurs relatively frequently in childhood, its manifestation in elderly patients is much rarer and typically presents with a more severe and torpid course. In older patients, the condition is often accompanied by pronounced visceral complications, including abdominal and renal syndromes, which significantly worsen the prognosis and require special attention in both diagnosis and treatment. This article presents a clinical case of hemorrhagic vasculitis in a geriatric patient. The disease manifested with the classical triad of symptoms: cutaneous purpura, abdominal pain syndrome, and renal involvement. Objective. To describe a clinical case of hemorrhagic vasculitis in an 86-year-old patient with concomitant cutaneous, abdominal, and renal syndromes on the background of significant comorbidities. Materials and Methods. This article presents the clinical case of an 86-year-old patient, V., who was admitted to the rheumatology department of the City Rheumatology Center in Almaty with complaints of hemorrhagic rashes on the upper and lower extremities, marked weakness, abdominal pain syndrome, episodes of nausea and vomiting, and oliguria. A comprehensive clinical, laboratory, and instrumental examination was conducted, including complete blood count, biochemical blood tests, urine analysis (including the Nechiporenko test), coagulation profile, immunological studies, abdominal ultrasound, ECG, and echocardiography. The diagnosis was established based on the patient’s complaints, clinical presentation, laboratory and instrumental findings, and in accordance with the EULAR (2010) classification criteria for adults. Results. The patient presented with typical symptoms of cutaneous hemorrhagic syndrome (symmetrical bluish-purple rashes that did not blanch under pressure), abdominal manifestations (nausea, vomiting, pain in the periumbilical area), and signs of renal involvement (episodes of oliguria, leukocyturia, elevated creatinine and urea levels). Under treatment with glucocorticosteroids, immunosuppressive therapy, infusion, and symptomatic therapy, positive dynamics were observed, including a reduction in the severity of skin manifestations, improvement in abdominal and renal symptoms, better laboratory values, and stabilization of the general condition. However, the disease course remained torpid, with prolonged healing of skin lesions, high sensitivity to medication changes, and the need for continuous cardiological and gastroenterological supervision. Conclusion. Early diagnosis, timely assessment of organ involvement, appropriate use of immunosuppressive and glucocorticosteroid therapy, and careful monitoring of complications are crucial for achieving favorable outcomes.