Funmi had purple, raised spots on both legs that didn't blanch when pressed. They appeared 2 weeks after a throat infection. Mascot Healthcare diagnosed IgA vasculitis and monitored her kidneys — which were the critical outcome measure.
First-year student, Akoka. Presented with a 5-day history of palpable purpuric rash on both lower legs, bilateral ankle joint pain, and mild periumbilical cramping. Two weeks prior: streptococcal pharyngitis treated with penicillin. No fever at presentation.
IgA Vasculitis (Henoch-Schönlein Purpura)Funmi had been recovering well from a throat infection when purple spots appeared on both lower legs. She thought she had bruised herself somehow. When she pressed a glass against one spot (a blanching test she had learned at a health talk), the colour did not disappear. She remembered the speaker saying "non-blanching purpura needs urgent assessment." She was right to come in immediately.
At Mascot Healthcare, the doctor examined the purpura, confirmed the non-blanching character, noted the ankle swelling, and asked specifically about recent infections and abdominal symptoms. The three-part history — post-infectious purpura, joint pain, abdominal cramps — was essentially diagnostic of IgA vasculitis.
Critically, the doctor ordered a urine dipstick immediately: trace haematuria and 1+ protein — evidence of renal involvement, the most serious complication of HSP.
IgA vasculitis (Henoch-Schönlein Purpura, HSP) is the most common vasculitis in young people — triggered by an immune response to a preceding infection. The classic tetrad: palpable purpura, arthralgia, abdominal pain, and kidney involvement.
Raised, purple-red spots on both lower legs and buttocks — non-blanching on pressure (differentiating from simple bruising).
Swollen, tender ankles and knees — arthralgia without joint destruction.
Intermittent, crampy abdominal pain — caused by IgA deposits in mesenteric vessels.
Pharyngotonsillitis 2 weeks earlier — the triggering infection.
Afebrile at presentation — distinguishing from septic conditions with purpura.
Applied glass blanching test (from health education) — correctly identified non-blanching purpura and sought help.
No other self-treatment — appropriately sought immediate medical assessment.
Blood tests: FBC (normal), ESR elevated at 44 mm/hr, CRP 18 mg/L, IgA 4.8 g/L (elevated), complement levels normal. Urine: haematuria + proteinuria → 24-hour urinary protein ordered. Renal function: normal creatinine at presentation.
The renal involvement (haematuria + proteinuria) made this IgA vasculitis with nephritis. Nephrology referral was made. An anti-inflammatory medication was started for the abdominal and joint symptoms. Haematuria and proteinuria resolved at 6-week follow-up urine dipstick.
Funmi was counselled: most HSP resolves fully in 4–8 weeks; renal disease complicates 40% of cases but serious persistent kidney damage is uncommon in young women with prompt monitoring.
IgA Vasculitis (Henoch-Schönlein Purpura) with nephritis — post-streptococcal; palpable purpura, arthralgia, abdominal pain, haematuria + proteinuria
An anti-inflammatory medication (for renal and GI involvement); nephrology referral; renal function monitoring; 24-hour urinary protein; joint pain relief (a painkiller); rest; recovery education
At 4 weeks: purpura resolved; joint pain resolved. At 6 weeks: urine dipstick normal; renal function normal. At 3 months: complete resolution.
Complete resolution of all manifestations by 3 months. Urine dipstick normal at 6-week follow-up. No long-term renal sequelae. Funmi was discharged from nephrology at 6 months.
Non-blanching purpura deserves urgent assessment — always. In a young person appearing generally well with joint pain and abdominal symptoms 1–2 weeks after an infection, IgA vasculitis is the most likely diagnosis.
The kidney is the critical organ to monitor in HSP. Urine dipstick for blood and protein should be performed at every visit — microscopic haematuria can be the first sign of nephritis requiring treatment.
Purple spots that don't blanch with glass pressure need urgent assessment. In young people after an infection — it's likely IgA vasculitis, and the kidneys need monitoring.
Book an appointment at Mascot Healthcare, Akoka — same-day slots often available, 4.9★ rated.