P4966 - A Rare Case of Eosinophilic Ileitis as a Feature of Immunoglobulin A Vasculitis in Late Adulthood

Magnus Chun, MD¹, Preet Patel, MD¹, Joseph Fayad, MD^2
1Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, NV; ²North Las Vegas VA Medical Center, Las Vegas, NV

Introduction: Eosinophilic ileitis (EI) is a rare condition accounting for less than 8% of all eosinophilic gastrointestinal disorders. EI is an allergic/immune-mediated disease characterized histopathologically by excess eosinophil deposition in the intestinal mucosa. We present the first recorded case of EI in an elderly patient as a manifestation of new onset Immunoglobulin A (IgA) vasculitis only diagnosed after ileal, renal, and skin biopsies.

Case Description/Methods: An 81-year-old female with a history of atopic dermatitis and hypertension presented with a month-long history of continuous dull abdominal pain and petechial rash in her extremities. The patient endorsed 4-5 loose non-bloody stools a day with no nausea, vomiting, or fevers. Stool culture and parasitological examination did not reveal any organisms. Inflammatory workup revealed elevated IgA, ESR, and CRP. Renal blood work revealed elevated BUN of 28 and creatinine of 1.15. Urinalysis showed proteinuria and elevated albumin to creatinine ratio. CT abdomen/pelvis revealed segmental circumferential wall thickening with surrounding fat stranding causing luminal narrowing of the distal ileus. Colonoscopy revealed moderate ileitis in the terminal ileum with multiple clean based ulcers in which biopsies were taken. Pathology of the ileal biopsies revealed inflammatory infiltrate within the lamina propria with eosinophils greater than 50/HPF, concerning for EI (Figure 1). She underwent elective renal biopsy revealing focal mesangial proliferative glomerulonephritis with immune complex deposits consistent with IgA vasculitis. Elective skin biopsy revealed leukocytoclastic vasculitis. She was treated with dupilumab until her rash resolved and oral prednisone for her IgA vasculitis with plans to repeat colonoscopy and CT imaging in 6 months.

Discussion: The incidence of IgA vasculitis is rare in adults and estimated to be 1.3 per 100,000. Intestinal features such as terminal ileitis have only been reported in pre-adolescence with IgA vasculitis. The etiology of eosinophilic ileitis from IgA vasculitis is unknown but it has been theorized that hyperactivation of IgA-laden Peyer’s patches in the ileum causes antigen mimicry leading to ileitis. Clinicians should consider IgA vasculitis as a differential diagnosis of patients with features of ileitis and obtaining a simple urine dip to unmask any underlying vasculitis is a crucial first step. Prednisone remains the initial therapy for IgA vasculitis and EI.



Disclosures:


Magnus Chun, MD¹, Preet Patel, MD¹, Joseph Fayad, MD². P4966 - A Rare Case of Eosinophilic Ileitis as a Feature of Immunoglobulin A Vasculitis in Late Adulthood, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.