CASE REPORT
Henoch-Schönlein purpura in an adult patient: a clinical case with dramatic presentation
Online publication date: 2013-06-26
Reumatologia 2013;51(3):229-232
KEYWORDS
ABSTRACT
Henoch-Schönlein purpura is a small-vessel vasculitis mostly affecting children and usually has a good prognosis. Adults, though affected rarely, may experience a more severe course of the disease. We present a case of a 65-year-old woman with Schönlein-Henoch purpura with dramatic course due to kidney and gastrointestinal involvement, with typical purpura and arthritis. Treatment with corticosteroids and cyclophosphamide was administered. Dialysis and surgical intervention were also required. Despite the treatment the patient's condition continued to deteriorate and finally she died of the disease. This case report shows that Schönlein-Henoch purpura may occur and have a severe clinical course in adults.
REFERENCES (22)
1.
Pillebout E, Thervet E, Hill G, et al. Henoch-Schönlein purpura in adults: outcome and prognostic factors. J Am Soc Nephrol 2002; 13: 1271-1278.
2.
Yang Y, Chuang Y, Wang L, et al. The immunobiology of Henoch--Schönlein purpura. Autoimmunity Rev 2008; 7: 179-184.
3.
Brogan P, Eleftheriou D, Dillon M. Small vessel vasculitis. Pediatr Nephrol 2010; 25: 1025-1035.
4.
Ozen S, Pistorio A, Iusan SM, et al.; Paediatric Rheumatology International Trials Organisation (PRINTO). EULAR/PRINTO/PRES criteria for Henoch-Schönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteria. Ann Rheum Dis 2010; 69: 798-806.
5.
Gardner-Medwin JM, Dolezalova P, Cummins C, Southwood TR. Incidence of Henoch-Schönlein purpura, Kawasaki disease, and rare vasculitides in children of different ethnic origins. Lancet 2002; 360: 1197-1202.
6.
Ebert EC. Gastrointestinal manifestations of Henoch-Schönlein purpura. Dig Dis Sci 2008; 53: 2011-2019.
7.
Watts RA, Carruthers DM, Scott DG. Epidemiology of systemic vasculitis: changing incidence or definition? Semin Arthritis Rheum 1995; 25: 28-34.
8.
Deng F, Lu L, Zhang Q, et al. Henoch-Schönlein purpura in childhood: treatment and prognosis. Analysis of 425 cases over a 5-year period. Clin Rheumatol 2010; 29: 369-374.
9.
Zaffanello M, Fanos V. Treatment-based literature of Henoch-Schönlein purpura nephritis in childhood. Pediatr Nephrol 2009; 24: 1901-1911.
10.
García-Porrúa C, Calvin~o MC, Llorca J, et al. Henoch-Schönlein purpura in children and adults: clinical differences in a defined population. Semin Arthritis Rheum 2002; 32: 149-156.
11.
Frigui M, Lehiani D, Koubaa M, et al. Acute pancreatitis as initial manifestation of adult Henoch-Schönlein purpura: report of a case and review of literature. Eur J Gastroenterol Hepatol 2011; 23: 189-192.
12.
Nakamura S, Hisamatsu T, Kikuchi J, et al. A case of IgA-related enteropathy complicated with gastrointestinal bleeding and progressive IgA nephropathy: a possible variant Henoch-Schönlein purpura? Intern Med 2010; 49: 1755-1761.
13.
Weiser JA, Rogers HD, Stokes MB, Grossman ME. Henoch-Schönlein purpura presenting with anuria in an adult. Cutis 2010; 86: 181-184.
14.
Carmichael P, Brun E, Jayawardene S, et al. A fatal case of bowel and cardiac involvement in Henoch-Schönlein purpura. Nephrol Dial Transplant 2002; 17: 497-499. .
15.
Chan JC, Li PK, Lai FM, Lai KN. Fatal adult Henoch-Schönlein purpura due to small intestinal infarction. J Intern Med 1992; 232: 181-184.
16.
Kalliakmani P, Benou E, Goumenos DS. Cyclosporin A in adult patients with Henoch-Schönlein purpura nephritis and nephrotic syndrome; 5 case reports. Clin Nephrol 2011; 75: 380-383.
17.
Muzaffar M, Taj A, Sethi N, Kaw D. Rapidly progressing glomerulonephritis secondary to Henoch-Schönlein purpura treated with mycophenolate mofetil: a case report with atypical etiology and presentation. Am J Ther 2010; 17: 163-166.
18.
Pillebout E, Alberti C, Guillevin L, et al. 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: 495-502.
19.
Rettig P, Cron RQ. Methotrexate used as a steroid-sparing agent in non-renal chronic Henoch-Schönlein purpura. Clin Exp Rheumatol 2003; 21: 767-769.
20.
Kusuda A, Migita K, Tsuboi M, et al. Successful treatment of adult-onset Henoch-Schönlein purpura nephritis with high-dose immunoglobulins. Intern Med 1999; 38: 376-379.
21.
Acar B, Arikan FI, Alioglu B, et al. Successful treatment of gastrointestinal involvement in Henoch-Schönlein purpura with plasmapheresis. Pediatr Nephrol 2008; 23: 2103-2103.
22.
Donnithorne KJ, Atkinson TP, Hinze CH, et al. Rituximab therapy for severe refractory chronic Henoch-Schönlein purpura. J Pediatr 2009; 155: 136-139.
Copyright: © Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie. This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (https://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
| eISSN: | 2084-9834 |
| ISSN: | 0034-6233 |
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