An adult patient with alcoholic liver cirrhosis and IgA vasculitis

63-year-old man with medical history of alcohol abuse presented with abdominal pain and bloody diarrhea, weakness, asthenia, anorexia, weight loss and since two weeks a skin rash on legs and arms. Physical examination revealed a distended abdomen with positive shifting dullness, right lower quadrant abdominal tenderness, palpable purpura involving arms, legs and abdominal wall, and pitting edema of hands and feet (fig 1). Laboratory studies demonstrated normal hemoglobin and white blood cells and decreased platelet count (128.000/µL). C-reactive protein (CRP) and renal function were normal. Stigmata of active alcohol abuse and shortened prothrombin time (50%) were present. Urinalysis revealed no blood or proteinuria. CT scan abdomen showed ileocolitis and an irregular liver parenchym pattern with mosaic aspect, without porta/ suprahepatic thrombosis and peritoneal fluid. Based on these findings, the tentative diagnoses of liver cirrhosis, vasculitis (possible IgA vasculitis despite negative urinary sediment) and colitis were made. Initial therapy consisted of fluid therapy, vitamin B1 and benzodiazepines. Further laboratory investigations including autoimmune and viral tests and a vasculitis work up were performed to exclude other causes of liver cirrhosis.