Low-dose corticosteroid with mizoribine might be an effective therapy for elderly-onset ISKDC grade VI IgA vasculitis.

Abstract

Both the diagnosis of elderly-onset IgA vasculitis (IgAV) and its prognosis can be difficult because of its rarity and the likely presence of comorbidities. Furthermore, the treatment of elderly-onset IgAV remains controversial: the ideal dosages of corticosteroid and/or immunosuppressants have not been determined. In the elderly, corticosteroid adverse effects can lead to severe outcomes, and a consensus regarding its benefit and risk balance has not been reached. We report a case of IgAV in an 89-year-old patient who was admitted to our hospital to investigate a 30-day history of palpable purpura and pitting edema on her leg. A renal biopsy showed membranoproliferative glomerulonephritis with IgA deposits (The International Study of Kidney Disease in Children (ISKDC) grade VI), which is a predictor of a poor prognosis; these findings led to early intervention with low-dose corticosteroid (15 mg/day) and mizoribine. As a result, a complete remission without obvious adverse effects was obtained. Early intervention with low-dose corticosteroid and mizoribine based on renal histopathology results might be an effective treatment for elderly-onset ISKDC grade VI IgAV.

• Authors: Hikaru Sugimoto, Shiho Matsuno, Noriko Yamanaka, Wako Yumura, Mitsuyo Itabashi, Takashi Takei
• Journal: CEN case reports (CEN Case Rep) Vol. 10 Issue 1 Pg. 46-52 (02 2021) ISSN: 2192-4449 [Electronic] Japan
• PMID: 32754805 (Publication Type: Case Reports, Journal Article)

Chemical References

• Adrenal Cortex Hormones
• Immunoglobulin A
• Immunosuppressive Agents
• Ribonucleosides
• mizoribine

Topics

• Adrenal Cortex Hormones (administration & dosage, therapeutic use)
• Aged, 80 and over
• Biopsy
• Comorbidity
• Drug Therapy, Combination
• Edema (diagnosis, etiology)
• Female
• Glomerulonephritis, Membranoproliferative (diagnosis, immunology, pathology)
• Humans
• IgA Vasculitis (diagnosis, etiology)
• Immunoglobulin A (immunology)
• Immunosuppressive Agents (administration & dosage, therapeutic use)
• Kidney (pathology)
• Leg (pathology)
• Nephrotic Syndrome (diagnosis, etiology)
• Remission Induction
• Ribonucleosides (administration & dosage, therapeutic use)
• Vasculitis (drug therapy, immunology, pathology)