Case of Gut Necrosis in Adult-Onset Immunoglobulin A Vasculitis (Henoch-Schönlein Purpura)

Imaging of intestinal vasculitis focusing on MR and CT enterography: a two-way street between radiologic findings and clinical data

Diagnosis of intestinal vasculitis is often challenging due to the non-specific clinical and imaging findings. Vasculitides with gastrointestinal (GI) manifestations are rare, but their diagnosis holds immense significance as late or missed recognition can result in high mortality rates. Given the resemblance of radiologic findings with some other entities, GI vasculitis is often overlooked on small bowel studies done using computed tomography/magnetic resonance enterography (CTE/MRE). Hereon, we reviewed radiologic findings of vasculitis with gastrointestinal involvement on CTE and MRE. The variety of findings on MRE/CTE depend upon the size of the involved vessels. Signs of intestinal ischemia, e.g., mural thickening, submucosal edema, mural hyperenhancement, and restricted diffusion on diffusion-weighted imaging, are common in intestinal vasculitis. Involvement of the abdominal aorta and the major visceral arteries is presented as concentric mural thickening, transmural calcification, luminal stenosis, occlusion, aneurysmal changes, and collateral vessels. Such findings can be observed particularly in large- and medium-vessel vasculitis. The presence of extra-intestinal findings, including within the liver, kidneys, or spleen in the form of focal areas of infarction or heterogeneous enhancement due to microvascular involvement, can be another radiologic clue in diagnosis of vasculitis. The link between the clinical/laboratory findings and MRE/CTE abnormalities needs to be corresponded when it comes to the diagnosis of intestinal vasculitis.

Risk factors of renal trauma in children with severe Henoch-Schonlein purpura and effect of mycophenolate mofetil on pediatric renal function

BACKGROUND

Renal trauma (RT) is a common feature in children with severe Henoch-Schonlein purpura (HSP), which can elevate the chance of recurrence and trigger end-stage renal disease. The risk factors of RT in children with HSP were explored and research was conducted on relevant treatment methods.

METHODS

A total of 120 child patients with severe HSP admitted to our hospital from January 2019 to January 2020 were selected as the research cohort, and divided into a RT group (n=45) and RT-free group (n=75) according to their condition to analyze the risk factors inducing RT in pediatric patients, and mycophenolate mofetil therapy was given to both participant groups to compare their renal function indicators, immune function indicators, and adverse reaction rates (ARR) after treatment.

RESULTS

Recurrent rash, adenovirus infection, respiratory virus infection, D-dimer level, leukocyte level, urinary albumin (UA) level, and platelet level were the risk factors of RT affecting severe HSP child patients. After treatment, the renal function indicators and immune indicators of participants in both groups were significantly better than those before treatment (P<0.05), and these indicators of the RT-free group were significantly better than the RT group after treatment (P<0.05). All participants did not experience serious adverse reactions, and no significant difference was presented when comparing the ARR between the 2 groups (P>0.05).

CONCLUSIONS

Recurrent rash, adenovirus infection, respiratory virus infection, D-dimer level, leukocyte level, UA level, and platelet level are the risk factors of RT affecting children with severe HSP, and mycophenolate mofetil can improve the renal function in pediatric patients and enhance their immunity, and is thus worthy of promotion in practice.