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Luciana B, Ilaria C, Isabella C, Gentile C, Grasso EA, Di Donato G, Francesco C, Verrotti A. Epidemiological and clinical aspects of immunoglobulin A vasculitis in childhood: a retrospective cohort study. Ital J Pediatr 2021; 47:237. [PMID: 34911536 PMCID: PMC8672591 DOI: 10.1186/s13052-021-01182-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/09/2021] [Indexed: 12/31/2022] Open
Abstract
Background A retrospective study was conducted in order to investigate and describe the characteristics of Immunoglobulin A vasculitis (IgAV), previously known as Henoch-Schӧnlein purpura, in the paediatric population of a community-based healthcare delivery system in the Italian region of Abruzzo. Methods This is a population-based retrospective chart review of the diagnosis of IgAV in children ages 0 to 18, admitted to the Department of Paediatrics of Chieti and Pescara between 1 January 2000 and 31 December 2016. All children enrolled presented with clinical symptoms and laboratory findings and met the EULAR/PRINTO/PRES 2008 criteria. Results Two-hundred-eight children met the criteria for IgAV, with the highest incidence reported among children below 7-years of age. A correlation with recent infections was found in 64% of the cohort; the onset was more frequently during the winter and fall. Purpura had a diffuse distribution in the majority of patients; joint impairment was the second most frequent symptom (43%), whereas the gastrointestinal tract was involved in 28% of patients. Conclusions Hereby, we confirm the relative benignity of IgAV in a cohort of Italian children; with regards to renal involvement, we report a better outcome compared to other studies. However, despite the low rate of renal disease, we observed a wide use of corticosteroids, especially for the treatment of persistent purpura.
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Affiliation(s)
- Breda Luciana
- Department of Paediatrics, University of Chieti, Via dei Vestini 31, Chieti, Italy.
| | - Carbone Ilaria
- Department of Paediatrics, University of Chieti, Via dei Vestini 31, Chieti, Italy
| | - Casciato Isabella
- Department of Paediatrics, University of Chieti, Via dei Vestini 31, Chieti, Italy
| | - Cristina Gentile
- Department of Paediatrics, University of Chieti, Via dei Vestini 31, Chieti, Italy
| | | | - Giulia Di Donato
- Department of Paediatrics, University of Chieti, Via dei Vestini 31, Chieti, Italy
| | - Chiarelli Francesco
- Department of Paediatrics, University of Chieti, Via dei Vestini 31, Chieti, Italy
| | - Alberto Verrotti
- Department of Paediatrics, University of Perugia, Piazza dell'Università 1, Perugia, Italy
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Duan H, Hua Y, Zhou K, Li Y, Wang C. A delayed diagnosis of late-onset pulmonary hemorrhage in a toddler with Henoch-Schönlein purpura after regression of skin rash: A case report and literature review. Medicine (Baltimore) 2020; 99:e23025. [PMID: 33126388 PMCID: PMC7598828 DOI: 10.1097/md.0000000000023025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
RATIONALE Pulmonary hemorrhage is a rare but fatal complication of Henoch-Schönlein purpura (HSP), and more easily ignored in children than in adults due to the absence of clinically evident hemoptysis. Moreover, despite being sporadically reported, given that pulmonary hemorrhage may develop after regression and even disappearance of skin rash, the asynchronous progression of skin and lung lesions poses escalating challenges in the timely diagnosis. We herein presented a delayed diagnosis of late-onset pulmonary hemorrhage in a child with HSP after regression of purpuric rash. PATIENT CONCERNS A 6-year and 3-month child with a history of self-resolved purpuric rash three weeks ago, presented acutely with cough and dyspnea but without fever. DIAGNOSES The decreased hemoglobin and diffuse ground-glass opacities of both lungs on CT scan weren't comprehensively evaluated. The child was initially misdiagnosed as pneumonia. INTERVENTIONS Antibiotic treatment was initiated. However, no improvement of respiratory status was found following aggressive combination therapy. Bronchoscopy was subsequently performed. OUTCOMES An diffuse alveolar hemorrhage with low inflammatory profile was noted after a bronchoscopy. Considering the history of HSP, the diagnosis of HSP-associated pulmonary hemorrhage was ultimately confirmed and the patient received corticosteroids with satisfactory results. LESSONS Pulmonary hemorrhage could occur in children with HSP at late onset of disease after regression of skin rash. New-onset respiratory symptoms in patients with a history of HSP should heighten suspicion for pulmonary hemorrhage, particularly if presenting with lack of fever, sudden drop of hemoglobin, new pulmonary infiltrates and unresponsiveness to antibiotics therapy. Bronchoscopy should be performed early to confirm the diagnosis, specifically for children.
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Affiliation(s)
- Hongyu Duan
- Department of Pediatrics
- The Cardiac development and early intervention unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu
| | - Yimin Hua
- Department of Pediatrics
- The Cardiac development and early intervention unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China
| | - Kaiyu Zhou
- Department of Pediatrics
- The Cardiac development and early intervention unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education Chengdu, Sichuan, China
| | - Yifei Li
- Department of Pediatrics
- The Cardiac development and early intervention unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu
| | - Chuan Wang
- Department of Pediatrics
- The Cardiac development and early intervention unit, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu
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Al E'ed A. Henoch-Schönlein purpura in Saudi Arabia: characteristics and rare vital organ involvement. Minerva Pediatr (Torino) 2020; 73:363-370. [PMID: 32960004 DOI: 10.23736/s2724-5276.20.05962-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Henoch-Schönlein purpura (HSP) is the most common small vessel vasculitis in children with an annual incidence of between 10 and 30 per 100,000. It is an inflammation that affects many organs primarily in the skin, gastrointestinal (GI) tract, musculoskeletal, also vital organs like kidneys and lungs which may lead to chronic kidney disease and pulmonary hemorrhage. In this review, we are showing the characteristics of Saudi patients with HSP and the relation with preceding infections, gender, and seasonal variations in addition to the common and most severe systemic involvements. We found cases that were challenging to diagnose and others with unfortunate fetal complications.
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Affiliation(s)
- Ashwaq Al E'ed
- Department of Pediatrics, College of Medicine, Qassim University, Qassim, Saudi Arabia -
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Di Pietro GM, Castellazzi ML, Mastrangelo A, Montini G, Marchisio P, Tagliabue C. Henoch-Schönlein Purpura in children: not only kidney but also lung. Pediatr Rheumatol Online J 2019; 17:75. [PMID: 31752918 PMCID: PMC6873759 DOI: 10.1186/s12969-019-0381-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/12/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Henoch-Schönlein Purpura (HSP) is the most common vasculitis of childhood and affects the small blood vessels. Pulmonary involvement is a rare complication of HSP and diffuse alveolar hemorrhage (DAH) is the most frequent clinical presentation. Little is known about the real incidence of lung involvement during HSP in the pediatric age and about its diagnosis, management and outcome. METHODS In order to discuss the main clinical findings and the diagnosis and management of lung involvement in children with HSP, we performed a review of the literature of the last 40 years. RESULTS We identified 23 pediatric cases of HSP with lung involvement. DAH was the most frequent clinical presentation of the disease. Although it can be identified by chest x-ray (CXR), bronchoalveolar lavage (BAL) is the gold standard for diagnosis. Pulse methylprednisolone is the first-line of therapy in children with DAH. An immunosuppressive regimen consisting of cyclophosphamide or azathioprine plus corticosteroids is required when respiratory failure occurs. Four of the twenty-three patients died, while 18 children had a resolution of the pulmonary involvement. CONCLUSIONS DAH is a life-threatening complication of HSP. Prompt diagnosis and adequate treatment are essential in order to achieve the best outcome.
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Affiliation(s)
- Giada Maria Di Pietro
- 0000 0004 1757 2822grid.4708.bFondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, 20122 Milan, Italy
| | - Massimo Luca Castellazzi
- ASST NORDMILANO, Ospedale di Sesto San Giovanni, Pediatric and Neonatology Unit, Sesto San Giovanni, 20099 Milan, Italy
| | - Antonio Mastrangelo
- 0000 0004 1757 2822grid.4708.bFondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, Pediatric Nephrology and Dialysis Unit, Università degli Studi di Milano, 20122 Milan, Italy
| | - Giovanni Montini
- 0000 0004 1757 2822grid.4708.bFondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, Pediatric Nephrology and Dialysis Unit, Università degli Studi di Milano, 20122 Milan, Italy
| | - Paola Marchisio
- 0000 0004 1757 2822grid.4708.bFondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, 20122 Milan, Italy
| | - Claudia Tagliabue
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatric Highly Intensive Care Unit, 20122, Milan, Italy.
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Miyoshi S, Nagao T, Kukida M, Miyoshi KI, Namba C, Kitazawa S, Nakamura Y, Hamaguchi N, Higaki J. Pulmonary Hemorrhaging as a Fatal Complication of IgA Vasculitis. Intern Med 2018; 57:3141-3147. [PMID: 29877284 PMCID: PMC6262698 DOI: 10.2169/internalmedicine.0817-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 64-year-old man was admitted to our hospital for purpuric rash, joint pain, and a fever. He had earlier undergone a follow-up examination for interstitial lung disease. At the current visit, the diagnosis was immunoglobulin A (IgA) vasculitis, based on skin and renal biopsy findings. He developed sudden breathlessness and hemoptysis. Chest computed tomography revealed ground glass opacity in the right lower lung fields, suggesting pulmonary hemorrhaging associated with IgA vasculitis. Despite steroid and cyclophosphamide therapy, and plasma exchange, he died 52 days after admission. Early aggressive therapies may be recommended for old patients with IgA vasculitis who have an additional comorbidities.
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Affiliation(s)
- Seigo Miyoshi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Tomoaki Nagao
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Masayoshi Kukida
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Ken-Ichi Miyoshi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Chika Namba
- Department of Dermatology, Ehime University Graduate School of Medicine, Japan
| | - Sohei Kitazawa
- Department of Molecular Pathology, Ehime University Graduate School of Medicine, Japan
| | - Yukihiro Nakamura
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Naohiko Hamaguchi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Japan
| | - Jitsuo Higaki
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Japan
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Ngobia A, Alsaied T, Unaka NI. Henoch-Schönlein purpura with hemoptysis: is it pneumonia or something else? Hosp Pediatr 2014; 4:316-20. [PMID: 25318115 DOI: 10.1542/hpeds.2014-0035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Anne Ngobia
- Pediatric Residency Training Program, Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Tarek Alsaied
- Pediatric Residency Training Program, Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ndidi I Unaka
- Pediatric Residency Training Program, Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Park SJ, Suh JS, Lee JH, Lee JW, Kim SH, Han KH, Shin JI. Advances in our understanding of the pathogenesis of Henoch-Schönlein purpura and the implications for improving its diagnosis. Expert Rev Clin Immunol 2014; 9:1223-38. [PMID: 24215411 DOI: 10.1586/1744666x.2013.850028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Henoch-Schönlein purpura (HSP) is a leukocytoclastic vasculitis classically characterized by palpable purpura, arthritis, abdominal pain and renal disease. In this article, we summarize our current understanding of the pathogenesis of HSP and the implications for improving its diagnosis. Although the pathogenesis of HSP is not fully understood yet, exciting new information has emerged in recent years, leading to a better understanding of its pathogenesis. Here, we discuss genetic predisposition, immunoglobulins with a particular emphasis on IgA1, activated complements, cytokines and chemokines, abnormal coagulation and autoantibodies in the underlying pathogenic mechanisms. Finally, diagnostic criteria for HSP developed by institutions such as the American College of Rheumatology and the European League against Rheumatism/Paediatric Rheumatology European Society were proposed to improve early detection and diagnosis.
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Affiliation(s)
- Se Jin Park
- Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
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8
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Rajagopala S, Shobha V, Devaraj U, D'Souza G, Garg I. Pulmonary Hemorrhage in Henoch-Schönlein Purpura: Case Report and Systematic Review of the English Literature. Semin Arthritis Rheum 2013; 42:391-400. [DOI: 10.1016/j.semarthrit.2012.07.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 07/12/2012] [Accepted: 07/14/2012] [Indexed: 11/15/2022]
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Abstract
INTRODUCTION This review addresses the pulmonary manifestations of the vasculitides, with a focus on diagnostic modalities. Haemorrhagic presentations (usually associated with nephritis: the pulmonary-renal syndrome) are the most common vasculitic cause of early death. AREAS COVERED The diagnostic modalities in the pulmonary vasculitides are reviewed, with a focus on primary systemic vasculitis. A literature search of original research and review articles on pulmonary vasculitides was undertaken using the PubMed database. EXPERT OPINION Small-vessel anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, especially granulomatosis with polyangiitis (Wegener's granulomatosis) are the most frequent causes of pulmonary vasculitis and typically present as nodules, alveolar infiltrates (haemorrhagic or not), cavities or tracheobronchial stenosis. Lung involvement is less common in large-vessel vasculitis when pulmonary vascular abnormalities can be seen. No single test is pathogonomonic and diagnosis requires integration of clinical, laboratory, imaging and histological findings. Treatment follows similar regimens to other vasculitic presentations, with glucocorticoids in conjunction with immunosuppressive agents, and management of intercurrent sepsis and the increased risk of cardiovascular and thromboembolic events. Prompt diagnosis and intensive treatment of pulmonary vasculitis is essential to improve early mortality and long-term outcomes.
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Affiliation(s)
- Alina Casian
- Addenbrooke's Hospital, Vasculitis and Lupus Clinic , Cambridge , UK
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10
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Chen SY, Chang KC, Yu MC, Asueh S, Ou LS. Pulmonary Hemorrhage Associated with Henoch-Schönlein Purpura in Pediatric Patients: Case Report and Review of the Literature. Semin Arthritis Rheum 2011; 41:305-12. [DOI: 10.1016/j.semarthrit.2011.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 03/30/2011] [Accepted: 03/30/2011] [Indexed: 10/18/2022]
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Abstract
Henoch-Schönlein purpura (HSP) is the most common form of vasculitis found in the pediatric population. The most common presenting complaint for children with HSP is a purpuric rash on the lower extremities. Many other organ systems beyond the skin can be involved for children with HSP. We report a case of a 7-year-old girl with HSP who presented with status epilepticus and onset of rash 2 weeks after her initial symptoms.
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12
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Sim YS, Choi MY, Oh JY, Lee JH, Moon JW, Choi KB, Ahn JH, Kim YK, Sung SH, Chang JH. A Case of Pulmonary Hemorrhage Associated with Henoch-Schönlein Purpura. Tuberc Respir Dis (Seoul) 2009. [DOI: 10.4046/trd.2009.67.3.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Yun Su Sim
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Moon Young Choi
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Ji Young Oh
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jin Hwa Lee
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jin Wook Moon
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Kyu Bock Choi
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jae Ho Ahn
- Department of Chest Surgery, Ewha Womans University College of Medicine, Seoul, Korea
| | - Yoo Kyung Kim
- Department of Diagnostic Radiology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Sun Hee Sung
- Department of Pathology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jung Hyun Chang
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
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Matsubayashi R, Matsubayashi T, Fujita N, Yokota T, Ohro Y, Enoki H. Pulmonary hemorrhage associated with Henoch-Schönlein purpura in a child. Clin Rheumatol 2008; 27:803-5. [PMID: 18196442 DOI: 10.1007/s10067-007-0832-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Accepted: 12/19/2007] [Indexed: 10/22/2022]
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Usui K, Ochiai T, Muto R, Abe I, Aikawa M, Kikushima K, Nagao K. Diffuse pulmonary hemorrhage as a fatal complication of Schönlein-Henoch purpura. J Dermatol 2007; 34:705-8. [PMID: 17908143 DOI: 10.1111/j.1346-8138.2007.00364.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a case of a 69-year-old man with Schönlein-Henoch purpura who developed diffuse pulmonary hemorrhage. He complained of dyspnea and hemoptysis while he was treated with steroids for gastroenteropathy associated with Schönlein-Henoch purpura. The drop in his hemoglobin levels and diffuse ground-glass opacity at all levels of the lung fields on chest computed tomography were a significant clue to diagnosis. Despite pulse therapy, no clinical improvement of the lung was achieved, and he died on the 36th day after the admission. Although the combination of the corticosteroid and immunosuppressive agents is normally recommended, diffuse pulmonary hemorrhage could become a fatal complication in elderly Schönlein-Henoch patients.
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Affiliation(s)
- Keiko Usui
- Department of Dermatology, Surugadai Nihon University Hospital, Chiyoda-ku, Tokyo, Japan.
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Goon SSH, Sathishkumar S, Siggers BR, Sadler PJ. A Case of Henoch-Schonlein Purpura with Multi-System Complications. J Intensive Care Soc 2007. [DOI: 10.1177/175114370700800124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Serena SH Goon
- Senior House Officer critical care, Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY
| | - Subramanian Sathishkumar
- Specialist registrar critical care and Anaesthesia, Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY
| | - Benet R Siggers
- Specialist Registrar Critical Care and Anaesthesia, Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY
| | - Paul J Sadler
- Consultant Critical Care and Anaesthesia, Queen Alexandra Hospital, Cosham, Portsmouth PO6 3LY
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Kalyoncu M, Cakir M, Erduran E, Okten A. Henoch-Schönlein purpura: a case with atypical presentation. Rheumatol Int 2005; 26:669-71. [PMID: 16180001 DOI: 10.1007/s00296-005-0032-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2004] [Accepted: 07/07/2005] [Indexed: 11/25/2022]
Abstract
We report on a case of Henoch-Schönlein purpura (HSP) with pulmonary hemorrhage and severe renal involvement. The patient also had active carditis related to acute rheumatic fever. He died despite intensive treatment. Regarding this case, we discuss the pathogenesis and clinical findings of pulmonary hemorrhage and active carditis in HSP.
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Affiliation(s)
- Mukaddes Kalyoncu
- Department of Pediatrics, Faculty of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey
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Abstract
OBJECTIVE To describe pulmonary involvement in Henoch-Schönlein purpura (HSP). PATIENTS AND METHODS We retrospectively reviewed the medical records of patients with HSP who were seen at the Mayo Clinic in Rochester, Minn, during a 6-year period (January 1, 1997, to December 31, 2002). Patients with HSP and pulmonary involvement were identified through a review of clinical records, radiological studies, pulmonary function data, and lung biopsy findings. RESULTS We identified 124 patients with HSP during the study period; 72 (58.1%) were males. The median age was 15 years (range, 8 months to 81 years). Among the 124 patients with HSP, 3 (2.4%), all adults, had pulmonary involvement. Of these 3 patients, aged 20, 67, and 76 years, 2 were women. Pulmonary manifestations consisted of diffuse alveolar hemorrhage (DAH) (2 patients) and usual interstitial pneumonia that improved with corticosteroid therapy (1 patient). CONCLUSIONS Pulmonary involvement in HSP is rare. It occurs more often in adults and commonly manifests as DAH and occasionally as usual interstitial pneumonia or interstitial fibrosis. Our cases and previously reported cases suggest that DAH is the most common manifestation of pulmonary involvement in HSP.
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Affiliation(s)
- Hassan F Nadrous
- Division of Pulmonary and Critical Care Medicine and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA
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18
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Abstract
Henoch-Schönlein purpura (HSP) is a multisystem immunoglobulin A-mediated vasculitis with a self-limited course affecting the skin, joints, gastrointestinal tract, and kidneys. HSP occurs most often in children between the ages of 3 and 10 years, and presents classically with a unique distribution of the rash to the lower extremities and the buttocks area. For this reason, a skin biopsy in children is rarely necessary for diagnosis. However, in the very young age children and adults, the rash is not classically distributed, and therefore a skin biopsy is often needed. Although there are currently no prospective controlled studies on the treatment of the different manifestations of HSP, there are several retrospectively designed studies and other physicians' personal experiences supporting the use of steroids in patients with severe gastrointestinal, severe renal, central nervous system, and testicular involvements. Severe renal and central nervous system disease may lead to life-threatening conditions, and immunosuppressive agents and plasmapheresis may be needed. The overall prognosis in HSP is excellent, but the long-term morbidity depends on the renal and neurologic involvement. One third to one half of these patients will have one or more recurrences of symptoms, usually within 6 weeks, but may occur as late as 3 to 7 years later.
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Affiliation(s)
- Abraham Gedalia
- Department of Pediatrics, Louisiana State University Health Sciences Center and Children's Hospital, 1542 Tulane Avenue, T8-1, New Orleans, LA 70112, USA.
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Teixeira A, Genereau T, Sutton L, Herson S, Cherin P. Implication of Occult Alveolar Hemorrhage in Henoch-Schönlein Purpura. J Clin Rheumatol 2002; 8:287-8. [PMID: 17041392 DOI: 10.1097/00124743-200210000-00017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lidar M, Pras M, Langevitz P, Livneh A. Thoracic and lung involvement in familial Mediterranean fever (FMF). Clin Chest Med 2002; 23:505-11. [PMID: 12092043 DOI: 10.1016/s0272-5231(01)00002-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Lung involvement in FMF is limited mainly to transient pleuritis during acute attacks. Amyloidosis of the lung is rare and is associated with symptomatic involvement of other organs while remaining subclinical in itself. Vasculitis of the lung in FMF is possible because of the strong association between FMF and a variety of vasculitides. With the exception of one case of isolated pulmonary vasculitis, vasculitis of the lung in FMF has not been described. The claim that FMF protects against asthma has not been established, but this inverse association, if present, may be traced to linkage disequilibrium in which MEFV modifies the effect of asthma and atopic-related genes, or to eosinophil function. Mesothelioma has been reported in at least four patients with FMF and is related to chronic or recurrent stimulation of the serous membrane. Three patients had peritoneal mesothelioma, while one developed mesothelioma of the lung. Finally, thromboembolism should be considered, particularly in patients with FMF amyloidosis who present with respiratory distress.
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Affiliation(s)
- Merav Lidar
- Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer, Israel
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Abstract
Henoch-Schönlein purpura (HSP) is an acute leukocytoclastic vasculitis that primarily affects children. In the current report, the author presents the clinical features of 100 children with HSP and reviews the literature, placing particular emphasis on new information concerning the etiology, immunopathogenesis, and treatment of HSP. The dominant clinical features of HSP are cutaneous purpura (100%), arthritis (82%), abdominal pain (63%), gastrointestinal bleeding (33%), and nephritis (40%). The etiology of HSP remains unknown, but it is clear that IgA plays a critical role in the immunopathogenesis of HSP, as evidenced by increased serum IgA concentrations, IgA-containing circulating immune complexes, and IgA deposition in vessel walls and renal mesangium. There are 2 subclasses of IgA, but HSP is associated with abnormalities involving IgA1 exclusively, and not IgA2. This finding may be a consequence of abnormal glycosylation of O-linked oligosaccharides unique to the hinge region of IgA1 molecules. Although several lines of evidence suggest a genetic susceptibility to HSP, the fundamental basis for the abnormalities involving IgA remain unclear. In general, HSP is an acute, self-limited illness, but one-third of patients will have 1 or more recurrences of symptoms. Corticosteroid therapy may hasten the resolution of arthritis and abdominal pain, but does not prevent recurrences. To date, no form of therapy has been shown to shorten appreciably the duration of HSP. The long-term prognosis of HSP is directly dependent on the severity of renal involvement. Corticosteroids in usual doses have no effect on established nephritis. Evidence is emerging that treatment with high-dose intravenous pulse methylprednisolone coupled with azathioprine or cyclophosphamide may be beneficial in patients with severe nephritis.
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Affiliation(s)
- F T Saulsbury
- Department of Pediatrics, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
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22
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Abstract
Familial Mediterranean fever (FMF) is a hereditary periodic fever syndrome expressed by acute episodes of fever and painful manifestations. In this report, the pulmonary manifestations of FMF are reviewed, the most prominent of which are chest attacks due to pleuritis. Nephropathic amyloidosis of the AA type, which complicates FMF in most untreated patients, may progress to affect other organs, including the lungs, but this rarely produces noticeable symptoms. The common association between FMF and vasculitis makes pulmonary hemorrhage, infarction, or infiltrates highly possible. These complications, however, have been reported only rarely. Asthma was found to occur less often than expected in patients with FMF, but methodologic faults make this finding doubtful. Finally, the occurrence of mesothelioma in five patients with FMF who were not exposed to asbestos suggests a role for recurrent FMF serositis in the pathogenesis of this malignancy.
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Affiliation(s)
- A Livneh
- Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer, Israel
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