<![CDATA[Henoch–Schönlein purpura (HSP), now known as IgA vasculitis (IgAV), is an immune-mediated small-vessel vasculitis that primarily affects children. Although its precise etiology remains unclear, group A streptococcal infection is a well-recognized potential immune trigger. The co-occurrence of IgAV, acute rheumatic fever (ARF), rheumatic heart disease (RHD), and Sydenham chorea is an extremely rare clinical phenotype with high educational value. We report an adolescent male presenting with the classic systemic tetrad of IgAV: generalized palpable purpura, migratory arthralgia, abdominal pain, and nephritis (hematuria and proteinuria). Laboratory testing revealed elevated anti-streptolysin O (ASLO) titers (400 IU/mL) after recent pharyngitis. Concurrently, the patient met the Jones criteria for ARF, with Sydenham chorea and echocardiographic evidence of carditis consistent with RHD. Skin biopsy confirmed leukocytoclastic vasculitis, though direct immunofluorescence (DIF) for tissue IgA deposition was unavailable. Treatment with systemic corticosteroids led to significant short-term clinical improvement. However, due to geographical constraints, the patient transferred care to his regional hospital, precluding long-term longitudinal assessment of proteinuria and glomerular filtration rate (GFR) at our tertiary center. This case highlights a challenging clinical intersection of post-streptococcal syndromes and IgAV. Although the lack of DIF and definitive bacterial cultures is a diagnostic limitation, the classical clinical presentation and histopathology strongly support the working diagnosis.]]>
