Mucosal Fibrosis on Biopsy Predicting Intestinal Perforation in Adult-Onset IgA Vasculitis: A Case Report.

We report a case of adult-onset IgA vasculitis that required surgery due to the perforation of the jejunum despite treatment with high-dose glucocorticoids and resolution of the inflammatory response. A mucosal biopsy before treatment revealed only localized fibrosis, while surgical pathology demonstrated ulceration and perforation with extensive submucosal fibrosis at the same site. These findings suggest that mucosal fibrotic changes observed on biopsy may indicate a risk of perforation and support the early use of cyclophosphamide or other agents for refractory disease.