A Year of Recurrent Gastroenteritis Treated with Antibiotics — First Reported Adult IgA Vasculitis from Nepal

Key finding

> **The antibiotics appeared to work.** Five times. That is the diagnostic trap, and it is more dangerous than a simple failure to diagnose. > > IgA vasculitis is a relapsing-remitting disease. Its gastrointestinal attacks resolve on their own. When a self-limiting attack is treated with a five-to-seven-day antibiotic course, the resolution coincides with the end of the course — and the clinician receives what looks like therapeutic confirmation of the infectious diagnosis. Each cycle strengthens the wrong hypothesis. This is a distinct and under-named failure mode: **an ineffective treatment that appears effective because the disease remits spontaneously on the treatment's timescale.** It converts a diagnostic uncertainty into a false certainty, and it does so repeatedly. The rash is the diagnostic key, and in this patient the rash was absent for nearly a year. IgAV is a small-vessel va

Framework connections: The Immune Priming, The Signal Fire (IL-6), The Undersized Filter (Renal-Metabolic)

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