Immunoglobulin A Vasculitis Associated Terminal Ileitis Mimicking Inflammatory Bowel Disease: Diagnostic Challenge and Therapeutic Role of Steroids - A Case Report.

Introduction: Gastrointestinal involvement in Henoch-Schönlein Purpura (immunoglobulin A [IgA] vasculitis) is common but can mimic other conditions, including inflammatory bowel disease, leading to diagnostic challenges. Case Presentation: We report a 19-year-old male who presented with a palpable purpuric rash and abdominal pain without significant renal involvement. Imaging with abdominal computed tomography and MR enteroclysis, as well as histopathology, revealed features of terminal ileitis and duodenitis, initially suggestive of inflammatory bowel disease. However, skin biopsy with immunofluorescence confirmed the diagnosis of IgA vasculitis. The patient demonstrated a rapid and dramatic clinical improvement following initiation of systemic glucocorticoid therapy. Conclusion: This case illustrates a rare diagnostic pitfall where IgA vasculitis can mimic inflammatory bowel disease. Recognition of this overlap is essential to avoid misdiagnosis, and timely initiation of glucocorticoids can lead to excellent therapeutic outcomes.