Abdominal pain with curious massive gastric ulcer: A case report of IgA vasculitis complicated with cytomegalovirus infection.

RATIONALE: Immunoglobulin A (IgA) vasculitis is a relatively rare autoimmune disorder in adults, typically affecting the skin, joints, kidneys, and gastrointestinal tract. It is often an overlooked cause of abdominal pain, and the diagnostic challenge is compounded when it coexists with infections. IgA vasculitis complicated by cytomegalovirus infection is a rare clinical scenario that presents significant challenges for diagnosis and treatment. This case is reported to raise awareness of the condition.

PATIENT CONCERNS: A 56-year-old female presented with abdominal pain, hematochezia, purpura, and reduced urine output. After corticosteroid treatment, her condition initially improved. However, 1 week later, the abdominal pain worsened, and gastroscopy revealed multiple large ulcers.

DIAGNOSES: The diagnosis of IgA vasculitis with concomitant cytomegalovirus (CMV) infection was confirmed based on clinical and endoscopic findings, CMV-DNA titer changes, and the patient's response to antiviral therapy.

INTERVENTIONS: Antiviral treatment for CMV was initiated, while corticosteroid therapy was gradually tapered.

OUTCOMES: The patient's abdominal pain significantly relieved, CMV-DNA levels decreased to normal, and follow-up gastroscopy showed a marked reduction in ulcer size.

LESSONS: During corticosteroid treatment for IgA vasculitis, if abdominal pain intensifies and multiple gastric ulcers are found on endoscopy, a high index of suspicion for an underlying infection, particularly CMV infection, is crucial. Raising awareness of this clinical scenario can improve diagnostic accuracy and enable prompt treatment adjustments.