Diagnosis and Management of Henoch-Schonlein Purpura in Indonesian Elderly with Severe Complication: A Rare Case

Overview

Journal Ann Med Surg (Lond)

Publisher Wolters Kluwer

Specialty Medical Education

Date 2022 May 31

PMID 35637989

Authors

Arinditia Triasti Putri

Awalia

Affiliations

Soon will be listed here.

Abstract

Background: Henoch-Schonlein purpura (HSP) in the elderly is very rare, so this case report was conducted to improve the diagnosis and management of HSP.

Case Presentation: A 65-year-old Indonesian male with severe complications of HSP had been reported. In addition to the patient's history, physical examination, laboratory and radiological findings, he performed a left sole anterior biopsy that showed interstitial infiltrate of main neutrophils, and faint granular deposits of IgA and C3 seen within the superficial vessels. He also had severe complications of gastrointestinal bleeding, extensive leukocytoclastic skin vasculitis, renal, and neurological manifestations. He had been given a pulse steroid, cyclophosphamide. He also planned to receive rituximab but canceled due to his worsening condition.

Discussion: Poor prognosis in the management of HSP in the elderly needs more attention to minimize mortality.

Conclusion: Management of HSP in the elderly patient is challenging as it is a rare case, with a tendency for severe manifestations and rapid progression.

References

Shah R, Ramakrishnan M, Vollmar A, Harrell A, Van Trump R, Masoud A . Henoch-Schönlein Purpura Presenting as Severe Gastrointestinal and Renal Involvement with Mixed Outcomes in an Adult Patient. Cureus. 2017; 9(3):e1088. PMC: 5384843. DOI: 10.7759/cureus.1088. View

Sharma A, Wanchu A, Kalra N, Singh S, Bambery P . Successful treatment of severe gastrointestinal involvement in adult-onset Henoch-Schönlein purpura. Singapore Med J. 2007; 48(11):1047-50. View

Maritati F, Canzian A, Fenaroli P, Vaglio A . Adult-onset IgA vasculitis (Henoch-Schönlein): Update on therapy. Presse Med. 2020; 49(3):104035. DOI: 10.1016/j.lpm.2020.104035. View

Yang Y, Yu H, Chiang B . The diagnosis and classification of Henoch-Schönlein purpura: an updated review. Autoimmun Rev. 2014; 13(4-5):355-8. DOI: 10.1016/j.autrev.2014.01.031. View

Audemard-Verger A, Pillebout E, Guillevin L, Thervet E, Terrier B . IgA vasculitis (Henoch-Shönlein purpura) in adults: Diagnostic and therapeutic aspects. Autoimmun Rev. 2015; 14(7):579-85. DOI: 10.1016/j.autrev.2015.02.003. View

Crayne C, Eloseily E, Mannion M, Azerf S, Weiser P, Beukelman T . Rituximab treatment for chronic steroid-dependent Henoch-Schonlein purpura: 8 cases and a review of the literature. Pediatr Rheumatol Online J. 2018; 16(1):71. PMC: 6236882. DOI: 10.1186/s12969-018-0285-2. View

Mei-Yen Yong A, Lee S, Tay Y . The profile of adult onset Henoch-Schönlein purpura in an Asian population. Int J Dermatol. 2015; 54(11):1236-41. DOI: 10.1111/ijd.12732. View

Lei W, Tsai P, Chu S, Kao Y, Lin C, Fang L . Incidence and risk factors for recurrent Henoch-Schönlein purpura in children from a 16-year nationwide database. Pediatr Rheumatol Online J. 2018; 16(1):25. PMC: 5902957. DOI: 10.1186/s12969-018-0247-8. View

Delapierre A, Terrier B, Pillebout E, Baudart P, Jourde-Chiche N, Lioger B . Clinical phenotype and cytokine profile of adult IgA vasculitis with joint involvement. Clin Rheumatol. 2022; 41(5):1483-1491. DOI: 10.1007/s10067-021-05937-8. View

10.

Pillebout E, Alberti C, Guillevin L, Ouslimani A, Thervet E . Addition of cyclophosphamide to steroids provides no benefit compared with steroids alone in treating adult patients with severe Henoch Schönlein Purpura. Kidney Int. 2010; 78(5):495-502. DOI: 10.1038/ki.2010.150. View

11.

Sasaki E, Shibata M, Kato A, Hamano N, Katsuki T, Tada M . An adult case of severe steroid-resistant Henoch-Schönlein purpura nephritis treated with intravenous cyclophosphamide and tonsillectomy. CEN Case Rep. 2017; 5(2):212-218. PMC: 5411647. DOI: 10.1007/s13730-016-0227-0. View

12.

Kaswala D, Chodos A, Ahlawat S . Henoch-Schonlein Purpura With Gastrointestinal Involvement in an Adult Patient. Gastroenterol Hepatol (N Y). 2016; 12(5):321-3. PMC: 4973562. View

13.

Hetland L, Susrud K, Hein Lindahl K, Bygum A . Henoch-Schönlein Purpura: A Literature Review. Acta Derm Venereol. 2017; 97(10):1160-1166. DOI: 10.2340/00015555-2733. View

14.

Hernandez-Rodriguez J, Carbonell C, Miron-Canelo J, Diez-Ruiz S, Marcos M, Chamorro A . Rituximab treatment for IgA vasculitis: A systematic review. Autoimmun Rev. 2020; 19(4):102490. DOI: 10.1016/j.autrev.2020.102490. View

15.

Hamzaoui A, Melki W, Harzallah O, Njim L, Klii R, Mahjoub S . Gastrointestinal involvement revealing Henoch Schonlein purpura in adults: Report of three cases and review of the literature. Int Arch Med. 2011; 4(1):31. PMC: 3213065. DOI: 10.1186/1755-7682-4-31. View

16.

Yaseen K, Herlitz L, Villa-Forte A . IgA Vasculitis in Adults: a Rare yet Challenging Disease. Curr Rheumatol Rep. 2021; 23(7):50. DOI: 10.1007/s11926-021-01013-x. View

17.

Maritati F, Fenoglio R, Pillebout E, Emmi G, Urban M, Rocco R . Brief Report: Rituximab for the Treatment of Adult-Onset IgA Vasculitis (Henoch-Schönlein). Arthritis Rheumatol. 2017; 70(1):109-114. DOI: 10.1002/art.40339. View

18.

Agha R, Franchi T, Sohrabi C, Mathew G, Kerwan A . The SCARE 2020 Guideline: Updating Consensus Surgical CAse REport (SCARE) Guidelines. Int J Surg. 2020; 84:226-230. DOI: 10.1016/j.ijsu.2020.10.034. View