Henoch-Schonlein purpura (HSP) is a vasculitis with IgA dominant immune complexes.¹ The small vessel vasculitis is characterised by inflammation and necrosis. We report a case of granulomatous HSP nephritis (HSPN) in association with keratitis and bilateral anterior granulomatous uveitis.

Case report

A 42 year old man presented to the casualty department with acute polyarthropathy, purpura, and nephritic syndrome. The urinalysis demonstrated 3+ blood and protein, blood pressure was 152/96, serum creatinine was 130 μmol/l, complement C3 titre was 0.78 g/l (normal 0.88–1.82), and immunoglobulin IgA titre was 4.6 g/litre (normal 0.80–2.80).

He underwent a left native kidney needle biopsy. Light microscopy demonstrated mesangial proliferative glomerulonephritis with no signs of interstitial nephritis. There was prominent vasculitis with a granulomatous response and fibrinoid necrosis (fig 1), mainly affecting the glomerular arterioles. Immunofluorescence studies demonstrated a predominantly granular staining for IgA and C3. Electron microscopy of the glomerulus demonstrated prominent endocapillary cellularity and neutrophil populations, with a number of subepithelial immune complexes.