Henoch-Schönlein Purpura Complicated with Severe Gastrointestinal Bleeding

Overview

Journal CEN Case Rep

Specialty Nephrology

Date 2017 May 17

PMID 28509281

Citations 7

Authors

Tomoyuki Yamazaki

Tetsu Akimoto

Yoshitaka Iwazu

Taro Sugase

Eri Takeshima

Akihiko Numata

Takanori Komada

Hiromichi Yoshizawa

Naoko Otani

Yoshiyuki Morishita

Osamu Saito

Fumi Takemoto

Shigeaki Muto

Eiji Kusano

Daisuke Nagata

Affiliations

Soon will be listed here.

Abstract

Bleeding from the gastrointestinal tract is one of the common determinants of morbidity and mortality in the ordinary clinical setting. The gastrointestinal involvement of Henoch-Schönlein purpura (HSP) has often been described as self-limiting, with no long-term morbidity. In this report, we describe our experience with a male HSP patient who presented with abdominal pain, loss of appetite and deteriorated renal function associated with nephrotic syndrome. Despite the use of aggressive immunomodulatory treatments, including corticosteroids and plasmapheresis, he developed lethal gastrointestinal hemorrhage. We believe that the accumulation of more experience with additional cases similar to ours is mandatory for the establishment of optimal management for HSP patients with severe gastrointestinal manifestations.

Citing Articles

The Clinical Effect and Safety of Dihuang Decoction in Henoch-Schönlein Purpura Compared With Different Traditional Programs: A Network Meta-Analysis.

Cui S, Liu L, Zhang F Cureus. 2024; 16(7):e64457.

PMID: 39007015 PMC: 11245892. DOI: 10.7759/cureus.64457.

[Immunoglobulin A vasculitis].

Adler S Inn Med (Heidelb). 2024; 65(2):114-121.

PMID: 38236411 DOI: 10.1007/s00108-023-01650-7.

Clinical analysis of 99 children with Henoch-Schönlein purpura complicated with overt gastrointestinal bleeding.

Yang Y, Shu J, Mu J, He Q, Chen F, Hu Y Clin Rheumatol. 2022; 41(12):3783-3790.

PMID: 35941339 DOI: 10.1007/s10067-022-06323-8.

Clinical characteristics and associating risk factors of gastrointestinal perforation in children with IgA vasculitis.

Guo Q, Hu X, Song C, Ren X, Zhai W, Ding Y Ann Med. 2021; 53(1):2315-2320.

PMID: 34878346 PMC: 8667883. DOI: 10.1080/07853890.2021.2009554.

IgA vasculitis.

Pillebout E, Sunderkotter C Semin Immunopathol. 2021; 43(5):729-738.

PMID: 34170395 DOI: 10.1007/s00281-021-00874-9.

References

Yamazaki T, Akimoto T, Okuda K, Sugase T, Takeshima E, Numata A . Purpura with ulcerative skin lesions and mixed cryoglobulinemia in a quiescent hepatitis B virus carrier. Intern Med. 2014; 53(2):115-9. DOI: 10.2169/internalmedicine.53.1203. View

Akimoto T, Saito O, Kusano E, Nagata D . Hypoalbuminemia and technetium-99m-labeled human serum albumin scintigraphy. Intern Med. 2014; 53(15):1723. DOI: 10.2169/internalmedicine.53.2538. View

Akimoto T, Otake T, Tanaka A, Takahashi H, Higashizawa T, Inoue M . Steroid treatment in patients with membranous nephropathy and hepatitis B virus surface antigenemia: a report of two cases. Clin Exp Nephrol. 2010; 15(2):289-93. DOI: 10.1007/s10157-010-0391-z. View

Nakamura S, Hisamatsu T, Kikuchi J, Adachi M, Yamagishi Y, Imaeda H . A case of IgA-related enteropathy complicated with gastrointestinal bleeding and progressive IgA nephropathy: a possible variant Henoch-Schönlein purpura?. Intern Med. 2010; 49(16):1755-61. DOI: 10.2169/internalmedicine.49.3678. View

Chan J, Li P, Lai F, Lai K . Fatal adult Henoch-Schönlein purpura due to small intestinal infarction. J Intern Med. 1992; 232(2):181-4. DOI: 10.1111/j.1365-2796.1992.tb00569.x. View

Yano T, Yamamoto H . Current state of double balloon endoscopy: the latest approach to small intestinal diseases. J Gastroenterol Hepatol. 2009; 24(2):185-92. DOI: 10.1111/j.1440-1746.2008.05773.x. View

Nakamura A, Fuchigami T, Inamo Y . Protein-losing enteropathy associated with Henoch-Schönlein purpura. Pediatr Rep. 2011; 2(2):e20. PMC: 3094002. DOI: 10.4081/pr.2010.e20. View

Hosono K, Endo H, Inamori M, Mawatari H, Iida H, Nozaki Y . Severe large-intestine involvement in adult-onset Henoch-Schönlein purpura: successful treatment with factor XIII concentrate. Digestion. 2008; 78(1):9. DOI: 10.1159/000151298. View

Esaki M, Matsumoto T, Nakamura S, Kawasaki M, Iwai K, Hirakawa K . GI involvement in Henoch-Schönlein purpura. Gastrointest Endosc. 2002; 56(6):920-3. DOI: 10.1067/mge.2002.129592. View

10.

Martinek J, Hlavova K, Zavada F, Seifert B, Rejchrt S, Urban O . "A surviving myth"--corticosteroids are still considered ulcerogenic by a majority of physicians. Scand J Gastroenterol. 2010; 45(10):1156-61. DOI: 10.3109/00365521.2010.497935. View

11.

Jeong Y, Ha H, Yoon C, Gong G, Kim P, Lee M . Gastrointestinal involvement in Henoch-Schönlein syndrome: CT findings. AJR Am J Roentgenol. 1997; 168(4):965-8. DOI: 10.2214/ajr.168.4.9124151. View

12.

Amoli M, Mattey D, Calvino M, Garcia-Porrua C, Thomson W, Hajeer A . Polymorphism at codon 469 of the intercellular adhesion molecule-1 locus is associated with protection against severe gastrointestinal complications in Henoch-Schönlein purpura. J Rheumatol. 2001; 28(5):1014-8. View

13.

Agha F, Nostrant T, Keren D . Leucocytoclastic vasculitis (hypersensitivity angiitis) of the small bowel presenting with severe gastrointestinal hemorrhage. Am J Gastroenterol. 1986; 81(3):195-8. View

14.

Kamitsuji H, Tani K, Yasui M, Taniguchi A, Taira K, Tsukada S . Activity of blood coagulation factor XIII as a prognostic indicator in patients with Henoch-Schönlein purpura. Efficacy of factor XIII substitution. Eur J Pediatr. 1987; 146(5):519-23. DOI: 10.1007/BF00441608. View

15.

Numata A, Akimoto T, Toshima M, Iwazu Y, Otani N, Miki T . Membranous nephropathy in an HIV-positive patient complicated with hepatitis B virus infection. Clin Exp Nephrol. 2011; 15(5):769-773. DOI: 10.1007/s10157-011-0477-2. View

16.

Raphael C, Shariff M, Cohen P, Smith G . An unusual case of gastrointestinal bleeding. Postgrad Med J. 2009; 85(1007):501-2. DOI: 10.1136/pgmj.2008.072959. View

17.

Yoshikawa N, Yamamura F, Akita Y, Sato T, Mitamura K . Gastrointestinal lesions in an adult patient with Henoch-Schönlein purpura. Hepatogastroenterology. 1999; 46(29):2823-4. View

18.

Lippl F, Huber W, Werner M, Nekarda H, Berger H, Weigert N . Life-threatening gastrointestinal bleeding due to a jejunal lesion of Henoch-Schönlein purpura. Endoscopy. 2001; 33(9):811-3. DOI: 10.1055/s-2001-16529. View

19.

Zhang Y, Huang X . Gastrointestinal involvement in Henoch-Schönlein purpura. Scand J Gastroenterol. 2008; 43(9):1038-43. DOI: 10.1080/00365520802101861. View

20.

Miniter U, Bae-Harboe Y, Powers J, Campbell S, Goldberg L . Fatal Henoch-Schonlein purpura in an adult related to bowel perforation: report and review of the literature. Dermatol Online J. 2012; 18(10):9. View