Acute appendicitis is a common pediatric surgical emergency, but its clinical presentation can overlap with other conditions, complicating diagnosis. We present a case of a 4-year-old female who initially presented with symptoms suggestive of appendicitis, including right iliac fossa pain, vomiting, and fever. Imaging studies were inconclusive, and a laparoscopic appendectomy was performed. No signs of appendicitis were found, but vasculitic changes were noted in a segment of the ileum. Postoperatively, the patient developed a mild purpuric rash, and elevated C-reactive protein (CRP) levels prompted further investigation. Subsequent laboratory tests and clinical findings led to a diagnosis of Immunoglobulin A (IgA) vasculitis, characterized by a small-vessel vasculitis affecting the gastrointestinal tract. This case highlights the diagnostic challenges when presenting symptoms mimic appendicitis but are ultimately attributed to an atypical presentation of IgA vasculitis. The importance of considering systemic inflammatory conditions like IgA vasculitis in pediatric abdominal pain is emphasized, especially when initial diagnoses do not align with imaging or surgical findings. A multidisciplinary approach, including rheumatological evaluation, was crucial in securing the correct diagnosis and managing the patient's care.

IgA vasculitis (IgAV) is a condition that causes inflammation of small blood vessels. It can often affect the skin, joints, kidneys, and digestive system. This condition usually involves the upper part of the small intestine, but in rare cases, it can affect the very end of the small intestine (terminal ileum). In our case, a patient came to the hospital with sudden, severe abdominal pain and imaging that suggested a localized bowel problem. Surgeons operated urgently, and only later (when a skin rash appeared) IgAV was diagnosed. The patient recovered quickly after starting steroid treatment, without needing further bowel procedures. This case shows that IgAV can sometimes look like a surgical emergency. By being aware of this possibility, we can prevent unnecessary surgery and guide treatment decisions.

Department of Surgery Masaryk University Brno Czech Republic

Faculty of Medical Sciences Lebanese University Beirut Lebanon

Mediclinic City Hospital Dubai Healthcare City Dubai UAE

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