Response to: Adult IgA vasculitis—look for triggers Free

First, we would like to thank Dr Sethi for his insightful comments. We agree that we should evaluate the involvement of IgA vasculitis in the heart and the potential cause of IgA vasculitis in the patient in this report.¹ The patient had a history of heavy smoking and had been aware of dyspnea when lying down for several months prior to admission. Echocardiography showed diffuse hypokinesis, low left ventricular ejection fraction (26%) and moderate mitral regurgitation. Coronary angiography revealed a severe three-vessel disease. Heart failure could not be treated with medication alone, but surgery, including coronary artery bypass surgery and mitral valvuloplasty, could make it easier. Of course, we cannot completely exclude the concordance of other cardiovascular diseases, including myocarditis. However, we can assume that myocardial ischemia was the primary cause in this case since the surgery well-controlled the patient’s heart failure.

In the acute phase of IgA vasculitis, the patient had microscopic hematuria but negative urine protein. The microscopic hematuria faded away over time. We performed exhaustive serologic testing to identify the various triggers of IgA vasculitis. All hepatitis antibodies were negative, as were antinuclear and antineutrophilic cytoplasmic antibodies, and there was no reduction in serum complement levels or high titration of antistreptolysin O. Serum cryoglobulin and rheumatoid factor were also negative, resulting in negative results for any of the extensive serologic tests identifying the various triggers for IgA vasculitis. As shown by Mitsui et al.,² the prevalence of malignancy among patients with adult-onset IgA vasculitis is as high as 29–43%. A whole-body computed tomography performed before surgery showed no evidence of solid organ cancer. Also, there was no history of drug abuse, including cocaine. In conclusion, we explored the possibility of secondary induction of IgA vasculitis in this case but could not identify an obvious cause. However, it is significant to look for the triggers of adult IgA vasculitis.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Conflict of interest

None declared.

Informed consent: The parent provided informed consent.

References