TP033 CASE REPORTS IN AUTOIMMUNE LUNG DISEASE / Thematic Poster Session An Unusual Presentation of IgA Vasculitis A Thota1, L Ramirez 2, U Naqvi1, A Mahgoub2, A Abdelrahman2; 1Pulmonary Medicine, Roger Williams Medical Center, Boston University School of Medicine, Providence, RI, United States, 2Roger Williams Medical Center, Providence, RI, United States Corresponding author's email: ajitkaran.reddy@gmail.com Introduction: IgA vasculitis is primarily a childhood disease but has also been reported in adults with very low incidence The classic tetrad of symptoms includes palpable purpura, arthralgia/arthritis, abdominal pain and renal involvement Involvement of other organ systems including the respiratory system has been reported but is uncommon Here, we present a case of IgA vasculitis where hemoptysis was the initial presenting symptom Case Report: A 32-year-old male with history of asthma and gastroesophageal reflux disease who presented to the hospital with intermittent hemoptysis for four days; approximately cups in amount He also was experiencing fatigue, episodic flushing, muscle cramps and weight loss for a few months On examination - he was afebrile, hypertensive with blood pressure of 170/84 mmHg, SpO2 was 98% on room air and there was evidence of purpuric skin rash in bilateral lower extremities Laboratory work up significant for elevated ESR of 30 mm/hr, CRP was normal at 1.1 mg/L Patient was noted to be in acute kidney injury (AKI) with a serum creatinine of 1.8 mg/dL (baseline 1.2), creatinine phosphokinase was elevated at 471 U/L and urine analysis showed 13 RBC/hpf, 2+ protein and granular casts Patient underwent a CTPA which did not reveal any pulmonary embolism but showed ground glass opacity in right upper lobe (Figure 1) Extensive immunological work up to evaluate for connective tissue disease including ANA, c-ANCA, p-ANCA, antiGBM, aldolase and complement levels were normal Hepatitis and HIV serologies were also negative A kidney biopsy was performed, and the pathology showed focal endocapillary, extracapillary proliferative and segmental glomerulonephritis, and immunofluorescence findings consistent with IgA nephropathy The patient received methyl-prednisone 1g for days followed by an extended taper regimen of prednisone, with marked improvement in symptomatology and resolution of his kidney and lung disease Discussion: IgA Vasculitis, a clinicopathologic syndrome formally known as HenochSchönlein purpura, typically presents with palpable purpura, arthralgias/arthritis, abdominal pain, GI bleeding and renal involvement Although pulmonary involvement is rare, with the highest incidence reported in a case series to be at 6.5%, complications can include diffuse alveolar hemorrhage, lung infection, and pulmonary vasculitis/capillaritis Hemoptysis was the initial presenting feature in our case, and associated other signs like purpura and clinical concern for rapidly progressive glomerulonephritis warranted kidney biopsy which confirmed the diagnosis Given the low incidence, further multicenter studies are required to identify IgA vasculitis with pulmonary involvement to determine the best immunosuppressive regimen This abstract is funded by: Am J Respir Crit Care Med 2021;203:A2032 Internet address: www.atsjournals.org Online Abstracts Issue