{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:05:39Z","timestamp":1756339539965,"version":"3.44.0"},"reference-count":18,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2020,7,5]],"date-time":"2020-07-05T00:00:00Z","timestamp":1593907200000},"content-version":"unspecified","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,6,12]]},"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:p>IgA vasculitis (Henoch-Sch\u00f6nlein purpura) affects various organs, including the skin, gastrointestinal (GI) tract, joints and kidneys. Its clinical course typically consists of two phases: initial appearance of purpura and delayed onset of arthralgia, GI symptoms and haematuria. We report the case of an adult patient with IgA vasculitis of the small bowel, without skin involvement, complicated by cytomegalovirus (CMV) enteritis following prednisolone administration. Single-balloon enteroscopy revealed mucosal oedema, redness, erosions and transverse ulcers of the duodenum and jejunum. Jejunal biopsy specimens showed IgA deposition in the capillary walls. CMV reactivation was confirmed by PCR and immunostaining using jejunal biopsy specimens. This case report strongly suggests that adult patients with IgA vasculitis can present with isolated GI involvement, without characteristic skin purpura. Furthermore, CMV reactivation needs to be considered in patients with IgA vasculitis showing poor response to glucocorticoids.<\/jats:p>","DOI":"10.1136\/bcr-2020-235042","type":"journal-article","created":{"date-parts":[[2020,7,7]],"date-time":"2020-07-07T06:05:23Z","timestamp":1594101923000},"page":"e235042","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Purpura-free small intestinal IgA vasculitis complicated by cytomegalovirus reactivation"],"prefix":"10.1136","volume":"13","author":[{"given":"Mariko","family":"Matsumura","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine Hospital, Osaka-Sayama, Osaka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoriaki","family":"Komeda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine Hospital, Osaka-Sayama, Osaka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomohiro","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine Hospital, Osaka-Sayama, Osaka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masatoshi","family":"Kudo","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine Hospital, Osaka-Sayama, Osaka, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,7,6]]},"reference":[{"key":"2025082710042285000_13.7.e235042.1","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1002\/art.1780330809","article-title":"The American College of rheumatology 1990 criteria for the classification of Henoch-Sch\u00f6nlein purpura","volume":"33","author":"Mills","year":"1990","journal-title":"Arthritis Rheum"},{"key":"2025082710042285000_13.7.e235042.2","doi-asserted-by":"publisher","DOI":"10.1097\/BOR.0b013e32835d8e2a"},{"key":"2025082710042285000_13.7.e235042.3","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780400513"},{"key":"2025082710042285000_13.7.e235042.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)11279-7"},{"key":"2025082710042285000_13.7.e235042.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-857X(05)70232-5"},{"key":"2025082710042285000_13.7.e235042.6","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.1016\/j.ejim.2017.05.025","article-title":"Positive predictive value of hospital discharge diagnosis code to identify immunoglobulin A vasculitis in France: a validation study","volume":"43","author":"Deshayes","year":"2017","journal-title":"Eur J Intern Med"},{"key":"2025082710042285000_13.7.e235042.7","doi-asserted-by":"publisher","DOI":"10.1080\/08035250410020181"},{"key":"2025082710042285000_13.7.e235042.8","doi-asserted-by":"publisher","DOI":"10.1097\/00005792-199911000-00005"},{"key":"2025082710042285000_13.7.e235042.9","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2009.167874"},{"key":"2025082710042285000_13.7.e235042.10","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1097\/PAS.0000000000001036","article-title":"Histologic features of gastrointestinal tract biopsies in IgA vasculitis (Henoch-Sch\u00f6nlein purpura)","volume":"42","author":"Louie","year":"2018","journal-title":"Am J Surg Pathol"},{"key":"2025082710042285000_13.7.e235042.11","doi-asserted-by":"crossref","first-page":"542","DOI":"10.5009\/gnl15198","article-title":"Endoscopic findings of upper gastrointestinal involvement in primary vasculitis","volume":"10","author":"Gong","year":"2016","journal-title":"Gut Liver"},{"key":"2025082710042285000_13.7.e235042.12","doi-asserted-by":"publisher","DOI":"10.1016\/0049-3848(89)90284-3"},{"key":"2025082710042285000_13.7.e235042.13","doi-asserted-by":"publisher","DOI":"10.1080\/00365520802101861"},{"key":"2025082710042285000_13.7.e235042.14","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1007\/BF01957748","article-title":"Gastrointestinal endoscopy in Henoch-Sch\u00f6nlein purpura","volume":"151","author":"Kato","year":"1992","journal-title":"Eur J Pediatr"},{"key":"2025082710042285000_13.7.e235042.15","doi-asserted-by":"crossref","first-page":"2354","DOI":"10.3748\/wjg.v11.i15.2354","article-title":"Endoscopic findings in a patient with Henoch-Schonlein purpura","volume":"11","author":"Chen","year":"2005","journal-title":"World J Gastroenterol"},{"key":"2025082710042285000_13.7.e235042.16","first-page":"645","article-title":"Infections and solid organ transplant rejection: a cause-and-effect relationship? 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