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Shende P, Reddy A, Faruqi AA, Kore T. A Rare Case of Immunoglobulin A Vasculitis in an Adult Male. Cureus 2024; 16:e56422. [PMID: 38638781 PMCID: PMC11024726 DOI: 10.7759/cureus.56422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
A 40-year-old Indian male presented with rash and abdominal pain, leading to a diagnosis of IgA vasculitis, a rare condition in adults. This systemic vasculitis involves IgA immune complex deposition, resulting in inflammation and tissue damage. Diagnosis relies on clinical features and biopsy findings, with management focused on symptom relief and addressing organ involvement. Long-term prognosis varies, emphasizing the importance of multidisciplinary care and patient education for optimal outcomes.
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Affiliation(s)
- Prakash Shende
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Avani Reddy
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Ahsan A Faruqi
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Tejas Kore
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
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Waleed M, Perinkulam Sathyanarayanan S, Arif Maan S, Mansoor L, Hoerschgen K. Terminal Ileitis as the Presenting Feature of Henoch-Schönlein Purpura in a 22-Year-Old Male. Cureus 2021; 13:e19406. [PMID: 34909326 PMCID: PMC8658736 DOI: 10.7759/cureus.19406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/05/2022] Open
Abstract
Henoch-Schönlein purpura (HSP) is a self-limited vasculitis that affects children and the preadolescent population. It is characterized by the deposition of immunoglobulin A immune complexes in tissues leading to palpable purpura, abdominal pain, arthritis, and nephropathy. When it occurs in adults, the clinical manifestations are the same; however, adults present with more significant renal involvement. While abdominal pain is the most common gastrointestinal (GI) manifestation, it can also present with GI bleeding, intussusception, bowel ischemia, and bowel perforation. Here, we report the case of a 22-year-old gentleman who presented with nonspecific GI complaints such as nausea, vomiting, and loose stools. He was later found to have terminal ileitis preceding the onset of rash, the biopsy of which confirmed HSP. Terminal ileitis is a rare GI manifestation of HSP and is not very commonly reported in the literature.
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Affiliation(s)
- Muhammad Waleed
- Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
| | | | - Soban Arif Maan
- Internal Medicine: Diabetes and Endocrinology, Aga Khan University Hospital, Karachi, PAK
| | - Linta Mansoor
- Internal Medicine, Faisalabad Medical University, Faisalabad, PAK
| | - Kayla Hoerschgen
- Pathology, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
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Khader Y, Burmeister C, Patel D, Ambati A, Altorok N. Henoch-Schonlein Purpura Presenting as Upper Gastrointestinal Bleed in an Adult Patient. Cureus 2021; 13:e13879. [PMID: 33868843 PMCID: PMC8043251 DOI: 10.7759/cureus.13879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Henoch-Schonlein purpura (HSP) is a multi-system autoimmune disease that is relatively common in pediatric patients. HSP usually manifests as palpable purpura, arthralgia, abdominal pain, and acute kidney injury. Here, we present a case of an adult male with hematemesis as the initial presenting symptom of HSP. A previously healthy, 18-year-old Caucasian male presented with a one-day history of hematemesis associated with abdominal pain and non-bloody diarrhea. He also reported bilateral knee and ankle arthralgias with a painless skin rash on both lower extremities. Physical exam was positive for palpable, purpuric, non-blanchable skin rash involving bilateral lower extremities. Notable labs on admission included a white cell count of 10.8 x 109/L and C-reactive protein of 4.8 mg/L. Upper endoscopy showed non-bleeding erosive gastropathy and duodenal erosions. Skin biopsy of the left leg showed immunoglobulin A (IgA) deposition within the walls of the superficial dermal vessels. The patient was started on intravenous methylprednisolone 500 mg daily followed by a steroid taper. Due to incomplete clinical response to steroids, mycophenolate mofetil 1000 mg twice daily was added and maintained for three months. His symptoms improved significantly, and he no longer complained of abdominal pain or diarrhea. Gastrointestinal manifestations are common in HSP patients. However, the diagnosis will be challenging when these symptoms precede other classical manifestations of HSP. History and physical exam are key components in accurately diagnosing HSP; nevertheless, skin biopsy remains the gold standard to confirm the diagnosis.
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Affiliation(s)
- Yasmin Khader
- Internal Medicine, University of Toledo, Toledo, USA
| | | | - Dipen Patel
- Internal Medicine, University of Toledo, Toledo, USA
| | - Amala Ambati
- Internal Medicine, University of Toledo, Toledo, USA
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The characteristics of video capsule endoscopy in pediatric Henoch-Schönlein purpura with gastrointestinal symptoms. Pediatr Rheumatol Online J 2020; 18:84. [PMID: 33115491 PMCID: PMC7592546 DOI: 10.1186/s12969-020-00471-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/06/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Henoch-Schönlein purpura (HSP) is a systemic small-vessel vasculitis also named IgA vasculitis that commonly affects the gastrointestinal tract. The video capsule endoscopy (VCE) characteristics of pediatric HSP patients are rarely reported. METHODS Patients diagnosed with HSP and analyzed by VCE examination at our hospital from February 2010 to January 2019 are enrolled. The clinical features, laboratory findings, and the characteristics of VCE findings are studied. RESULTS There are 30 patients enrolled in this investigation from February 2010 to January 2020. The mean age of these patients is 96.9 ± 35.8 months, and the most frequent finding of VCE is mucosal erosion, which account for 79.3% of the patients, and followed by mucosal erythema or petechia accounted for 69% of the patients. Regarding the disease location detected by endoscopy, jejunum is the most common involved part of the gastrointestinal tract in pediatric HSP patients. All the patients had the jejunum involved except in one patient the VCE did not pass through the pylorus. One third of the patients involved the descending portion of duodenum. No side effect is observed in this study. CONCLUSIONS VCE may be an excellent adjust tool for evaluation of the gastrointestinal tract in children with abdominal symptoms without typical purpura in suspected pediatric HSP patients. VCE appears to be superior to esophagogastroduodenoscopy in detecting small intestinal lesions of HSP and has an excellent safety profile.
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Zhang X, Furth EE, Tondon R. Vasculitis Involving the Gastrointestinal System Is Often Incidental but Critically Important. Am J Clin Pathol 2020; 154:536-552. [PMID: 32789454 DOI: 10.1093/ajcp/aqaa083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES This study was aimed to investigate the significance of unexpected vasculitis identified in gastrointestinal (GI) specimens by determining its prevalence and correlation with clinical outcomes. METHODS GI specimens with histologic evidence of vasculitis were identified in our pathology database over a 10-year period (January 2008 to August 2018). Clinical history, treatment, and follow-up were reviewed. RESULTS Of the 131,367 GI pathology cases received over the 10-year study period, 29 (0.02%) cases showed histologic evidence of GI vasculitis. The majority (69%, 20/29) were not clinically suspected. Of these, 20% (4/20) of patients were subsequently diagnosed with systemic vasculitis. During the mean follow-up period of 34.0 months, 24% (4/17) of the patients with this unexpected diagnosis died as the result of direct complications of GI vasculitis. We also found that 95% of cases with unexpected vasculitis in their GI pathology specimens were communicated in a timely manner to the ordering physicians, which necessitated the immediate initiation of additional workups in 85% of these patients. CONCLUSIONS The GI involvement of vasculitis is rarely encountered by pathologists, but its diagnosis carries tremendous clinical significance with a high mortality rate. Therefore, timely communication is highly recommended for the early diagnosis and treatment of this disease.
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Affiliation(s)
- Xiaoming Zhang
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Emma Elizabeth Furth
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Rashmi Tondon
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
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Matsumura M, Komeda Y, Watanabe T, Kudo M. Purpura-free small intestinal IgA vasculitis complicated by cytomegalovirus reactivation. BMJ Case Rep 2020; 13:13/7/e235042. [PMID: 32636227 PMCID: PMC7342267 DOI: 10.1136/bcr-2020-235042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IgA vasculitis (Henoch-Schönlein purpura) affects various organs, including the skin, gastrointestinal (GI) tract, joints and kidneys. Its clinical course typically consists of two phases: initial appearance of purpura and delayed onset of arthralgia, GI symptoms and haematuria. We report the case of an adult patient with IgA vasculitis of the small bowel, without skin involvement, complicated by cytomegalovirus (CMV) enteritis following prednisolone administration. Single-balloon enteroscopy revealed mucosal oedema, redness, erosions and transverse ulcers of the duodenum and jejunum. Jejunal biopsy specimens showed IgA deposition in the capillary walls. CMV reactivation was confirmed by PCR and immunostaining using jejunal biopsy specimens. This case report strongly suggests that adult patients with IgA vasculitis can present with isolated GI involvement, without characteristic skin purpura. Furthermore, CMV reactivation needs to be considered in patients with IgA vasculitis showing poor response to glucocorticoids.
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Affiliation(s)
- Mariko Matsumura
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine Hospital, Osaka-Sayama, Osaka, Japan
| | - Yoriaki Komeda
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine Hospital, Osaka-Sayama, Osaka, Japan
| | - Tomohiro Watanabe
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine Hospital, Osaka-Sayama, Osaka, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine Hospital, Osaka-Sayama, Osaka, Japan
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Adult-Onset Immunoglobulin A Vasculitis. ACG Case Rep J 2020; 7:e00306. [PMID: 32337300 PMCID: PMC7162119 DOI: 10.14309/crj.0000000000000306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 11/07/2019] [Indexed: 11/26/2022] Open
Abstract
Immunoglobulin A vasculitis (IgAV), formerly Henoch–Schönlein purpura vasculitis, is a vasculitis commonly seen in children and only rarely described in adult patients. IgAV can present as arthralgia, rash, discolored urine, acute kidney injury, and gastrointestinal symptoms. We present a case of a 56-year-old man who presented with 1 month of worsening abdominal pain followed by a bilateral lower extremity rash. Laboratory evaluation indicated an acute kidney injury. Computed tomography and colonoscopy revealed terminal ileitis while kidney biopsy confirmed a diagnosis of IgAV.
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Abstract
Rheumatological diseases (RDs) represent a diverse group of diseases that are inherited or related to environmental factors. RDs frequently affect the gastrointestinal (GI) tract, and gastroenterologists are often asked to evaluate patients with symptoms thought to represent an underlying or coexisting RD. GI manifestations of RDs vary based on the organ involved as well as the extent and duration of involvement. Although most manifestations of RD are nonspecific and not life-threatening, the chronicity and severity of symptoms can be debilitating and may lead to serious injury. This narrative review discusses the most common RD encountered by gastroenterologists: systemic lupus erythematosus, systemic sclerosis (scleroderma), dermatomyositis/polymyositis, rheumatoid arthritis, Sjögren syndrome, overlap syndromes, mixed connective tissue disease, Ehlers-Danlos syndromes, and other vasculitides. Each section begins with a brief overview of the condition, followed by a discussion of the etiopathophysiology, physical examination findings, GI manifestations, diagnostic tools (i.e., serologic, imaging, endoscopic, and functional), and treatment options.
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Miao M, Li X, Wang Q, Zhu Y, Cui Y, Shao X. Association between anti-α-1,4-D-polygalacturonic acid antibodies and Henoch-Schönlein purpura in children. J Int Med Res 2019; 47:2545-2554. [PMID: 31068035 PMCID: PMC6567704 DOI: 10.1177/0300060519843728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Objective To investigate the relationship between anti-α-1,4-D-polygalacturonic acid (PGA) antibodies, particularly immunoglobulin (Ig)A, and Henoch-Schönlein purpura (HSP) in children. Methods This observational case–control study investigated PGA-IgA, PGA-IgG, and PGA/PGA-IgA circulating immune complex (PGA/PGA-IgA CIC) in paediatric patients with HSP versus controls. Children with HSP were also evaluated for food specific IgG and food intolerance. Between-group differences in anti-PGA antibodies were analysed. Results Serum PGA-IgA and PGA-IgG levels were significantly increased in patients with acute HSP (n = 251) versus those with urticaria (n = 48), acute respiratory infections (n = 95), surgical controls (n = 53) and neonates (n = 92). PGA/PGA-IgA CIC levels were also significantly higher in the acute HSP group versus surgical control and neonate groups. Levels of PGA/PGA-IgA CIC and PGA-IgA were significantly correlated (r = 0.997), and PGA-IgA showed high diagnostic specificity for HSP. No statistically significant differences were observed in PGA-IgA and PGA-IgG between various degrees of food intolerance in children with HSP. Conclusion Increased anti-PGA antibodies, particularly PGA-IgA and PGA/PGA-IgA CIC, were significantly associated with acute HSP in children. Food intolerance was not found to be associated with increased anti-PGA antibodies in children with HSP.
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Affiliation(s)
- Meihua Miao
- Department of Clinical Laboratory, Children's Hospital of Soochow University, Suzhou, China
| | - Xiaozhong Li
- Department of Clinical Laboratory, Children's Hospital of Soochow University, Suzhou, China
| | - Qin Wang
- Department of Immunology, School of Biology and Basic Medical Science, Soochow University, Suzhou, China
| | - Yunfen Zhu
- Department of Clinical Laboratory, Children's Hospital of Soochow University, Suzhou, China
| | - Yanyan Cui
- Department of Clinical Laboratory, Children's Hospital of Soochow University, Suzhou, China
| | - Xuejun Shao
- Department of Clinical Laboratory, Children's Hospital of Soochow University, Suzhou, China
- Xuejun Shao, Department of Clinical Laboratory, Children's Hospital of Soochow University, 92 Zhongnan Street, Suzhou Industrial Park, Suzhou 215025, Jiangsu Province, China.
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Han Y, Jin SY, Kim DW, Jeen YM, Kim YH, Choi IH. Endoscopic and microscopic findings of gastrointestinal tract in Henoch-Schönlein purpura: Single institute experience with review of literature. Medicine (Baltimore) 2019; 98:e15643. [PMID: 31096484 PMCID: PMC6531244 DOI: 10.1097/md.0000000000015643] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Asia has the highest incidence of Henoch-Schönlein purpura (HSP). Although 50% to 75% of patients with HSP manifest gastrointestinal (GI) symptoms, endoscopic, and pathologic findings of HSP have been rarely reviewed in Asia.Patients diagnosed with HSP who had undergone endoscopic biopsy from GI tract (GIT) in Soonchunhyang University Seoul Hospital from 2000 to 2018 were evaluated and 25 cases with 44 biopsies from upper GI tract (U-GIT) or lower GI tract (L-GIT) were enrolled. Their clinical and endoscopic findings and histologic findings of endoscopic biopsy were reviewed.Of the 25 patients, 15 were males and 10 were females. There were 6 children and 19 adults. The most common GI symptom was abdominal pain (20/25), followed by loose stool or diarrhea (9/25). Biopsied sites included 19 from U-GIT (9 stomach and 10 duodenum) and 25 from L-GIT (7 terminal ileum, 1 cecum, 4 ascending, 1 transverse, 2 descending, 7 sigmoid, and 3 rectum). Erythema/petechia was the most common endoscopic finding in U-GIT, while erosion/ulceration was the most common one in L-GIT. In U-GIT, extravasted red blood cell (RBC) (14/19) was the most common histologic finding, while leukocytoclastic vasculitis (LCV)/capillarities were identified in 7 specimens, including 5 duodenum samples. In endoscopic investigations of L-GIT, erosion/ulceration (9/14) was predominantly identified. The most common histologic finding was also extravasted RBC (22/25), while LCV/capillarities were noted in 10 specimens, including 5 specimens from terminal ileum.The HSP commonly involves GIT. Histologic findings of our cases were not significantly different from results of previous studies in Western countries. However, endoscopic and pathologic characteristics of HSP have been rarely reviewed in Asia. Herein, we share experience of endoscopic biopsy of GIT in patients with HSP.
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Xu Y, Wang JJ, Liu FF, Wu Y, Wu YF, Samadli S, Luo HH, Zhang DD, Hu P. Predisposing factors of childhood Henoch-Schönlein purpura in Anhui province, China. J Investig Med 2018; 67:771-778. [PMID: 30530785 DOI: 10.1136/jim-2018-000906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 12/12/2022]
Abstract
Henoch-Schönlein purpura (HSP) is a common autoimmune vasculitis in childhood. The detailed pathogenesis of HSP is still unclear, whereas several types of predisposing factors have been proved to be the initial step. The objectives of present study were to analyze the distribution of predisposing factors, association of the predisposing factors with clinical manifestations and HSP relapse/recurrence. 1200 children with HSP were recruited between January 2015 and December 2017. We reviewed their laboratory tests and medical histories associated with HSP onset. The annual incidence of HSP was 8.13-9.17 per 100 000 in Anhui province. HSP occurred more commonly in spring and winter than in summer with an obvious west-to-east gradient. Cutaneous purpura was the most prevalent manifestation (100%), followed by arthritis/arthralgias (43.67%), abdominal pain (40.17%) and renal involvement (18.17%). On admission, series of potential infections were identified in 611 patients (50.92%). The histories of allergy, injury, surgery, vaccination and tick bite were declared by 231 patients (19.25%), 15 patients (1.25%), 12 patients (1.00%), 4 patients (0.33%) and 3 patients (0.25%), respectively. However, predisposing factors could not be identified in 521 children with HSP (43.42%) yet. 123 cases (10.25%) relapsed or recurred more than one time; the mean number was 2.92, and the mean interval was 11.4 weeks. The infection is the most frequent predisposing factor regardless of clinical phenotypes and relapse/recurrence, whereas the clinical manifestations exhibit an obvious heterogenicity according to different predisposing factors.
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Affiliation(s)
- Yao Xu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jing Jing Wang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Fei Fei Liu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yue Wu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yang Fang Wu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Sama Samadli
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Huang Huang Luo
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Dong Dong Zhang
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Peng Hu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Abstract
IgA vasculitis is primarily a pediatric disease that is rarely encountered in adults. With adults, gastrointestinal manifestations are quite common, yet are nonspecific and may overlap with other diseases, particularly Crohn's disease, which can make the diagnosis a challenging task. Treatment is controversial given the disease course is usually self-limited with few serious complications. We present a case of IgA vasculitis in an adult patient with limited extraintestinal findings illustrating the complexity of arriving at the correct diagnosis.
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Toshihiko K, Tomonobu A. Henoch-Schönlein purpura with preceding abdominal pain. Clin Case Rep 2015; 3:513-4. [PMID: 26185663 PMCID: PMC4498877 DOI: 10.1002/ccr3.248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 02/20/2015] [Indexed: 11/16/2022] Open
Abstract
Diagnosing HSP can be difficult, especially when abdominal symptoms precede the onset of characteristic palpable purpura (Chen MJ et al. 2005, World Gastroenterol., 11, 2354). Therefore, it is necessary to consider the possibility of HSP in patients with prolonged strong abdominal pain, even in cases without purpura.
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Affiliation(s)
- Kakiuchi Toshihiko
- Department of Pediatrics, Faculty of Medcine, Saga University Saga, Japan
| | - Aoki Tomonobu
- Department of Interdisciplinary Medicine, Fukuoka Children's Hospital & Medical Center for Infectious Diseases Fukuoka, Japan
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Gonen KA, Erfan G, Oznur M, Erdogan C. The first case of Henoch-Schonlein purpura associated with rosuvastatin: colonic involvement coexisting with small intestine. BMJ Case Rep 2014; 2014:bcr-2013-202644. [PMID: 24648473 DOI: 10.1136/bcr-2013-202644] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Henoch-Schönlein purpura (HSP) is a systemic vasculitis affecting small vessels. It is the most common systemic vasculitis in children, and is rare in adults. Serious gastrointestinal complications are more common in childhood. Infections and drugs are the most prominent factors in the aetiology. Wall thickening in segments of the small intestine is commonly seen in imaging studies in gastrointestinal system (GIS) involvement. Simultaneous involvement of small intestine and colon is rare. An HSP case involving small intestine and colon in an adult patient due to the use of rosuvastatin, an antihyperlipidaemic agent, is presented, and is first of its kind reported in the literature.
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Affiliation(s)
- Korcan Aysun Gonen
- Department of Radiology, School of Medicine, Namik Kemal University, Tekirdag, Turkey
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Jang SY, Kim JH, Ha SH, Hwang JA, Park SJ, Paik SY. [A case of idiopathic recurrent duodenojejunitis]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012; 59:245-9. [PMID: 22460574 DOI: 10.4166/kjg.2012.59.3.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
There are various etiologies of duodenojejunitis such as Henoch-Schönlei purpura (H-S purpura), vasculitis, Crohn's disease, celiac sprue, ischemia, lymphoma, Zollinger-Ellison syndrome, bacteria or parasite infection, radiation, drug induced jejunitis, eosinophilic jejunitis, and toxins. A 31-year-old man presented with left upper quadrant pain. He did not have febrile sense, hematochezia, melena, diarrhea, arthralgia and hematuria. He had neither drug history nor traveling history. Esophagogastroduodenoscopy showed diffuse mucosal erythema and segmental hemorrhagic erosions on the distal area to the descending portion of the duodenum and proximal jejunum, which were commonly observed in the gastrointestinal involvement of H-S purpura. However, he showed no skin lesions, joint and urologic problems until the discharge. Autoimmune markers such as antinuclear antibody and antineutrophil cytoplasmic antibody were negative. Celiac and mesenteric angiogram showed no vascular abnormality. After the administration of oral prednisolone 40 mg daily for therapeutic trial, abdominal pain and endoscopic lesions were improved. He experienced relapses of same episode without skin lesions 16 times during follow-up of 8 years, which were also treated with prednisolone. The abdominal computed tomography during the follow-up also showed no significant finding. We report a case of primary recurrent duodenojejunitis similar to the gastrointestinal involvement of H-S purpura without purpura.
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Affiliation(s)
- Sung Yeol Jang
- Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea
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Kim YO, Choi YS, Won YH, Kim YD, Woo YJ, Back HJ, Cho YK, Han DK, Song ES. Intestinal amebiasis with Henoch-Schönlein purpura. Pediatr Int 2010; 52:667-9. [PMID: 20958879 DOI: 10.1111/j.1442-200x.2010.03116.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Young Ok Kim
- Department of Pediatrics, School of Medicine, Chonnam National University, Gwangju, Korea.
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Nakamura S, Hisamatsu T, Kikuchi J, Adachi M, Yamagishi Y, Imaeda H, Hosoe N, Naganuma M, Ebinuma H, Okamoto S, Kanai T, Ogata H, Hanaoka H, Furuya Y, Kawano Y, Bokuda K, Sasamura H, Uchida H, Endo T, Hashiguchi A, Kameyama K, Mukai M, Hibi T. A case of IgA-related enteropathy complicated with gastrointestinal bleeding and progressive IgA nephropathy: a possible variant Henoch-Schönlein purpura? Intern Med 2010; 49:1755-61. [PMID: 20720354 DOI: 10.2169/internalmedicine.49.3678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Here, we report an adult patient with IgA-related enteropathy complicated with massive intestinal bleeding and acute renal failure, but without skin lesions. Surgical resection of the small intestine and steroid pulse therapy was performed. Histopathology revealed significant deposition of IgA and C3 in the small vessels of the intestine and the kidney mesangium. Although skin purpura was absent, the histopathology and clinical manifestations suggested that the pathophysiology was similar to Henoch-Schönlein purpura (HSP), implying IgA-related enteropathy as a subclass of HSP. Retrospective analysis indicates that terminal ileum lesions may be a poor prognostic indicator.
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Affiliation(s)
- Shoko Nakamura
- The Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
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[Abdominal manifestations of Henoch-Schönlein purpura in adults. A retrospective study of 23 cases]. Rev Med Interne 2009; 30:661-70. [PMID: 19375200 DOI: 10.1016/j.revmed.2009.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2008] [Revised: 02/12/2009] [Accepted: 02/24/2009] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Gastrointestinal manifestations of Henoch-Schönlein purpura (HSP) in adults may be severe. Data about treatment are controversial and the outcome is seldom described. METHODS Twenty-three patients with gastrointestinal manifestations of HSP (ACR criteria) were retrospectively studied. We proposed to use clinical and radiological (CT scan) severity scores to assess the usefulness and the efficacy of corticosteroid therapy. RESULTS Age at onset ranged from 16 to 80 years (median 39). Gastrointestinal manifestations included abdominal pain (96%), vomiting (52%), gastrointestinal bleeding (39%), diarrhoea (13%) and intestinal obstruction (9%). Scores of disease clinical severity were calculated in 21 patients. Fourteen, three and four had severe, intermediate and mild disease, respectively. Ten patients in the group with severe clinical involvement underwent CT scan that showed severe radiological involvement (parietal thickening of several bowel loops of the same segment or several segments with ileal involvement). Eleven patients out of 14 with clinically severe disease were given corticosteroids. Two patients out of three with intermediate and three patients out of four with mild scores also received corticosteroids. The others received supportive care. In-patients with severe clinical scores, gastrointestinal symptoms improved within 2 days when they were given corticosteroids and within 12.3 days without corticosteroids (p<0.0002). No side effect was observed with steroid therapy. CONCLUSION These results suggest that corticosteroids may reduce abdominal symptoms of HSP in adults with clinically severe disease. They are safe when CT scan is performed.
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Henoch-Schönlein purpura presenting with multiplex gastrointestinal manifestations and massive nephrotic syndrome in adulthood — a case report. Open Med (Wars) 2008. [DOI: 10.2478/s11536-008-0060-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractHenoch-Schönlein purpura (HSP) is a systemic small vessel vasculitis mainly affecting children. We report a case of a 49-year-old woman with severe gastrointestinal and renal involvement of HSP. Endoscopy revealed more characteristic findings in the terminal ileum than in the gastric antrum. Histological examinations of the biopsy samples from the ileum, antrum, skin and kidney confirmed the diagnosis of HSP. Parenteral corticosteroid therapy led to a rapid improvement of the gastrointestinal symptoms, but because of the excessive proteinuria intravenous cyclophosphamide therapy had to be introduced.
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Gastrointestinal manifestations of Henoch-Schonlein Purpura. Dig Dis Sci 2008; 53:2011-9. [PMID: 18351468 DOI: 10.1007/s10620-007-0147-0] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Accepted: 11/24/2007] [Indexed: 12/11/2022]
Abstract
Henoch-Schonlein Purpura (HSP) is the most common systemic vasculitis in childhood. The diagnostic criteria include palpable purpura with at least one other manifestation -- abdominal pain, IgA deposition, arthritis or arthralgia, or renal involvement. Immune complex deposits result in necrosis of the wall of small- and medium-sized arteries with infiltration of tissue by neutrophils and deposition of nuclear fragments, a process called leukocytoclastic vasculitis (LCV). It is often associated with infections, medications, or tumors. It may coexist with or mimic Crohn's disease. Periumbilical and epigastric pain worsens with meals, from bowel angina. Bleeding is usually occult or, less commonly, associated with melena. Intussusception, the most common surgical complication, is usually ileo-ileo or ileo-colic. Perforations, usually ileal, may occur spontaneously or be associated with intussusception. Ultrasound, recommended as the first diagnostic test, and CT scans may show intussusception and asymmetric bowel wall thickening mainly involving the jejunum and ileum. There are a range of endoscopic findings including gastritis, duodenitis, ulceration, and purpura, with the second portion of the duodenum characteristically being involved more than the bulb. Intestinal biopsies show IgA deposition and LCV in the submucosal vessels. Superficial biopsies may show inflammation, ulceration, edema, hemorrhage, and vascular congestion, presumably due to vasculitis-induced mucosal ischemia. The efficacy of corticosteroids in preventing severe complications or relapses is controversial. The majority of patients, however, improve spontaneously.
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Takagi E, Umeda K, Kurokawa I, Mizutani H, Iwasaki M. Clinical and histopathological features in Henoch-Schönlein purpura. Int J Dermatol 2008; 47:48-9. [PMID: 18173601 DOI: 10.1111/j.1365-4632.2007.03354.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Emiko Takagi
- Department of Dermatology, Mie University Graduate School of Medicine, and Division of Surgery, Mie University Hospital, Iwasaki Hospital
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Chen MJ, Chang WH, Chu CH, Wang TE, Lin SC, Shih SC. Rapid response of Henoch-Schönlein purpura to corticosteroids: correlation between skin and gastric mucosal lesions. Dig Dis Sci 2007; 52:1706-8. [PMID: 17404873 DOI: 10.1007/s10620-006-9568-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2006] [Accepted: 08/10/2006] [Indexed: 12/09/2022]
Affiliation(s)
- Ming-Jen Chen
- Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital and Mackay Medicine, Nursing and Management College, Taipei, Taiwan.
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Benjilali L, Harmouche H, Maamar M, Tazi Mezalek Z, Aouni M, Adnaoui M, Hamani Z, Maaouni A. [Adult rheumatoid purpura revealed by intestinal ischemic syndrome]. ACTA ACUST UNITED AC 2006; 30:1323-4. [PMID: 17185979 DOI: 10.1016/s0399-8320(06)73545-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Andriani A, Zullo A, Di Raimondo F, Patti C, Tedeschi L, Recine U, Caruso L, Bonanno G, Chiarenza A, Lizzani G, Miedico A, Romanelli A, Costa A, Linea C, Marrone C, Mirto S, Mistretta A, Montalbano L, Restivo G, Vinci M, Bibas M, Hassan C, Stella F, Cottone M, Morini S. Clinical and endoscopic presentation of primary gastric lymphoma: a multicentre study. Aliment Pharmacol Ther 2006; 23:721-6. [PMID: 16556173 DOI: 10.1111/j.1365-2036.2006.02826.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although the stomach is the most frequent site of intestinal lymphomas, few data are available on both clinical endoscopic presentation of gastric lymphoma and possible differences between low-grade and high-grade lymphomas. METHODS Clinical, histological and endoscopic records of consecutive patients with primary low-grade or high-grade lymphoma diagnosed were retrieved. Symptoms were categorized as 'alarm' or 'not alarm'. The endoscopic findings were classified as 'normal' or 'abnormal'. RESULTS Overall, 144 patients with primary gastric lymphoma were detected, including 74 low-grade and 70 high-grade lymphoma. Alarm symptoms, particularly persistent vomiting and weight loss, were more frequently present in patients with high-grade lymphoma than in those with low-grade lymphoma (54% vs. 28%; P = 0.002). Low-grade lymphomas presented as 'normal' appearing mucosa (20% vs. 0%; P = 0.0004) or petechial haemorrhage in the fundus (9% vs. 0%; P = 0.02) more frequently than high-grade lymphomas, being also more often confined to the antrum (47% vs. 27%, P = 0.03) and associated with Helicobacter pylori infection (88% vs. 52%, P < 0.0001). On the contrary, high-grade lymphomas presented more commonly as ulcerative type (70% vs. 52%; P = 0.03), being also more frequently diagnosed in stage >I when compared with low-grade lymphomas (70% vs. 21%, P < 0.0001). CONCLUSIONS The overall prevalence of alarm symptoms is quite low and may be absent in more than 70% of patients with low-grade lymphoma.
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Affiliation(s)
- A Andriani
- Department of Haematology and Gastroenterology, 'San Giacomo' and 'Nuovo Regina Margherita' Hospitals, Rome, Italy
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Schneider A, Merikhi A, Frank BB. Autoimmune disorders: gastrointestinal manifestations and endoscopic findings. Gastrointest Endosc Clin N Am 2006; 16:133-51. [PMID: 16546029 DOI: 10.1016/j.giec.2006.01.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The gastrointestinal tract can be involved in many autoimmune disorders, and women are affected more than men in most of the disease processes discussed. As this article outlines, gastrointestinal manifestations can be either part of the clinical presentation or complications of treatment. Depending on the disease process and the severity of symptoms, gastrointestinal evaluation and treatment can have an important role in the management of these diseases.
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Affiliation(s)
- Alison Schneider
- Division of Gastroenterology, Drexel University College of Medicine, Philadelphia, PA 19107, USA
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