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Banbury S, Milgraum DM, Lewis DJ, Queenan M, Treat JR. Post-streptococcal small-vessel vasculitis in a 16-month-old with associated intussusception and hypertension: Henoch Schönlein purpura? Pediatr Dermatol 2024. [PMID: 38631675 DOI: 10.1111/pde.15599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 02/24/2024] [Indexed: 04/19/2024]
Abstract
Henoch Schönlein purpura (HSP), also known as IgA vasculitis, is a systemic small-vessel vasculitis typically occurring in children 3-15 years of age, with peak incidence at 4-6 years. It is characterized by a constellation of symptoms including palpable purpura, arthralgias or arthritis, abdominal pain including intussusception, and renal involvement. We report a patient with these clinical findings whose IgA immunofluorescence was negative but with a presumptive diagnosis of HSP at 16 months of age, significantly younger than the classic population. This condition rarely affects this age group, and we highlight the importance of considering vasculitis in children of all ages, as a failure to diagnose could lead to insufficient long-term monitoring, particularly regarding renal function.
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Affiliation(s)
- Sara Banbury
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David M Milgraum
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Daniel J Lewis
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maria Queenan
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - James R Treat
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Yeganeh MH, Sinaei R, Rouhi M, Shiari R, Parvaneh VJ, Rahmani K, Sheikhbahaei E. Investigating the comparative effect of vitamin D level with the type of complications in Henoch Schönlein purpura and Kawasaki disease. Reumatol Clin (Engl Ed) 2024; 20:199-203. [PMID: 38644031 DOI: 10.1016/j.reumae.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/23/2023] [Accepted: 12/29/2023] [Indexed: 04/23/2024]
Abstract
INTRODUCTION AND OBJECTIVES Henoch Schönlein purpura (HSP) and Kawasaki disease (KD) are two main inflammatory diseases among childhood vasculitis. Considering the anti-inflammatory effects of 25-hydroxyvitamin D3, we decided to investigate the association of serum 25-hydroxy vitamin D3 level with the type and severity of these conditions. MATERIALS AND METHODS The present study was performed as a historical cohort of 254 affected children with KD and HSP vasculitis. The required data were extracted, using a researcher-made questionnaire from patients' electronic file, and then they were analyzed after collecting information of the patients. RESULTS In HSP group, 54% of participants were boys. Similarly, in KD group, boys were more affected than girls. The comparative 25-hydroxyvitamin vitamin D3 level in HSP patients with and without renal involvement (P=0.02), hematuria (P=0.14), and in two groups with and without heart disease, and also with and without coronary artery dilatation in KD patients (P<0.001) were significant. DISCUSSION AND CONCLUSIONS The findings showed that insufficient level of vitamin D3 were significantly associated with the exacerbation of complications of both diseases, and therefore it seems that vitamin D deficiency can be an effective predictive factor of severity in HSP and KD patients.
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Affiliation(s)
| | - Reza Sinaei
- Department of Pediatrics, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran; Clinical Research Development Unit, Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Mitra Rouhi
- Department of Pediatrics, School of Medicine, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Reza Shiari
- Department of Pediatric Rheumatology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vadood Javadi Parvaneh
- Department of Pediatrics, School of Medicine, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khosro Rahmani
- Department of Pediatric Rheumatology, School of Medicine, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Erfan Sheikhbahaei
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Kaneta KA, Adler R. Purpuric Vesiculobullous Rash in IgA Vasculitis (IgAV). J Pediatr 2022; 251:217-218. [PMID: 35970238 DOI: 10.1016/j.jpeds.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Kelli A Kaneta
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Robert Adler
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California; University of Southern California, Los Angeles, California
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Poudel P, Adams SH, Mirchia K, Jain H, Eranki A. IgA negative immunofluorescence in diagnoses of adult-onset Henoch-Schönlein purpura. Proc (Bayl Univ Med Cent) 2020; 33:436-7. [PMID: 32675977 DOI: 10.1080/08998280.2020.1770526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 10/24/2022] Open
Abstract
We describe two cases of young adult men presenting with diffuse petechial rash and gastrointestinal disturbances. They were found to have leukocytoclastic vasculitis without immunoglobulin A findings under direct immunofluorescence on skin biopsy histopathology performed over a week after the appearance of lesions. Henoch Schönlein purpura (HSP) was diagnosed based upon the clinical presentation as well as the leukocytoclastic vasculitis biopsy findings.
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Neufeld M, Molyneux K, Pappelbaum KI, Mayer-Hain S, von Hodenberg C, Ehrchen J, Barratt J, Suzuki Y, Sunderkötter C. Galactose-deficient IgA1 in skin and serum from patients with skin-limited and systemic IgA vasculitis. J Am Acad Dermatol 2019; 81:1078-1085. [PMID: 30902725 DOI: 10.1016/j.jaad.2019.03.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 03/02/2019] [Accepted: 03/10/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND IgA vasculitis (IgAV) encompasses a systemic form involving kidneys, gut, skin, or joints, and a skin-limited form. One characteristic feature of systemic IgAV is deposition of galactose-deficient IgA1 (GD-IgA1) in kidneys (as in IgA nephropathy). The relevance of GD-IgA1 for cutaneous vasculitis is unknown. OBJECTIVE We investigated whether GD-IgA1 is deposited perivascularly in systemic and also skin-limited IgAV and whether its serum levels differ between both forms. METHODS In a case-control study, deposition of GD-IgA1 was analyzed immunohistochemically by KM55 antibody in skin biopsy specimens from 12 patients with skin-limited IgAV and 4 with systemic IgAV. GD-IgA1 levels were compared by enzyme-linked immunosorbent assay in sera from 15 patients each with skin-limited and systemic IgAV and from 11 healthy individuals. RESULTS All biopsy samples from systemic IgAV, and also from skin-limited IgAV, revealed perivascular GD-IgA1 deposition. The average GD-IgA1 concentration in serum was significantly higher in systemic IgAV than in skin-limited IgAV, despite overlap between the groups. LIMITATIONS Although high GD-IgA1 levels may be predictive of systemic IgAV, patient numbers were too low to determine cutoff values for systemic versus skin-limited IgAV. CONCLUSION Perivascular GD-IgA1 deposition is a prerequisite for systemic and skin-limited IgAV; however, high GD-IgA1 levels in some patients with systemic IgAV suggest a dose-dependent effect of GD-IgA1 in IgAV.
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Affiliation(s)
- Matthias Neufeld
- Department of Translational Dermatoinfectiology, University of Münster, Münster, Germany; Department of Dermatology, University of Münster, Münster, Germany
| | - Karen Molyneux
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
| | - Karin I Pappelbaum
- Department of Translational Dermatoinfectiology, University of Münster, Münster, Germany
| | - Sarah Mayer-Hain
- Department of Translational Dermatoinfectiology, University of Münster, Münster, Germany
| | - Christina von Hodenberg
- Department of Translational Dermatoinfectiology, University of Münster, Münster, Germany; Department of Dermatology, University of Münster, Münster, Germany
| | - Jan Ehrchen
- Department of Translational Dermatoinfectiology, University of Münster, Münster, Germany; Department of Dermatology, University of Münster, Münster, Germany
| | - Jonathan Barratt
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
| | - Yusuke Suzuki
- Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Cord Sunderkötter
- Department of Translational Dermatoinfectiology, University of Münster, Münster, Germany; Department of Dermatology and Venereology, University Hospital of Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
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Hočevar A, Tomšič M, Pižem J, Bolha L, Sodin-Šemrl S, Glavač D. MicroRNA expression in the affected skin of adult patients with IgA vasculitis. Clin Rheumatol 2018; 38:339-345. [PMID: 30084048 DOI: 10.1007/s10067-018-4250-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 07/30/2018] [Indexed: 11/26/2022]
Abstract
IgA vasculitis (IgAV) represents a common systemic vasculitis in pediatric and adult population. Our current knowledge of disease pathogenesis is still very limited, without information on miRNAs in IgAV. The aim of our study was to determine the expression of five pre-selected miRNAs (miRNA-146a-5p, miRNA-148-3p, miRNA-155-5p, miRNA-223-3p, and let-7b) in the affected skin of adult IgAV patients. The study included 65 skin samples from consecutive, untreated IgAV patients (61.5% male, median age 67.6 years, range 29-91), diagnosed between October 2014 and September 2016, and 20 samples of normal skin from healthy volunteers. Total RNA was isolated from tissue sections of formalin-fixed, paraffin-embedded samples. Expression of miRNAs was measured using qRT-PCR. To present relative miRNA expression, the ΔΔCT method was used. Skin miRNA expression was correlated to clinical characteristics of adult IgAV patients. We found significantly higher levels of miRNA-155-5p, miRNA-223-3p, and let-7b in the affected skin compared to controls (18.6-fold, 6.4-fold, and 7.9-fold higher respectively). Contrary, the miRNA 148-3p expression was significantly lower (2.2-fold). The expression of the miRNA-146-5p showed near normal levels. Patients with necrotic skin lesions had significantly higher miRNA-223 tissue expression than those with non-necrotic purpura (p = 0.029). Gastrointestinal tract involvement inversely correlated with the expression of miRNA-155-5p and/or miRNA-146a-5p in affected skin. Altered expression of miRNA-148b-3p, miRNA-155-5p, miRNA-223-3p, and let-7b was found in vasculitic skin lesions in IgAV. Additionally, we found a positive association between the severity of purpura and skin miRNA-223-3p expression. Aberrantly expressed miRNAs could represent a biomarker in adult IgAV.
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Affiliation(s)
- Alojzija Hočevar
- Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova cesta 62, 1000, Ljubljana, Slovenia.
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
| | - Matija Tomšič
- Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova cesta 62, 1000, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jože Pižem
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Luka Bolha
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Snežna Sodin-Šemrl
- Department of Rheumatology, University Medical Centre Ljubljana, Vodnikova cesta 62, 1000, Ljubljana, Slovenia
- Faculty of Mathematics, Natural Science and Information Technologies University of Primorska, Koper, Slovenia
| | - Damjan Glavač
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Lee CD, Williams SE, Sathe NA, McPheeters ML. A systematic review of validated methods to capture several rare conditions using administrative or claims data. Vaccine 2014; 31 Suppl 10:K21-7. [PMID: 24331071 DOI: 10.1016/j.vaccine.2013.03.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 03/22/2013] [Accepted: 03/25/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE To identify and assess billing, procedural, or diagnosis code, or pharmacy claim-based algorithms used to identify the following health outcomes in administrative and claims databases: acute disseminated encephalomyelitis (ADEM), optic neuritis, tics, and Henoch Schönlein purpura (HSP). METHODS We searched the MEDLINE database from 1991 to September 2012 using controlled vocabulary and key terms related to the conditions. We also searched the reference lists of included studies. Two investigators independently assessed the full text of studies against pre-determined inclusion criteria and extracted case validation data from those studies meeting inclusion criteria. RESULTS Two eligible studies addressed ADEM, two addressed optic neuritis, and four studies addressed tics. Only one study addressed HSP. Among these, one study of ADEM reported a positive predictive value of 66%, however the identification algorithm contained a combination of International Classification of Diseases (ICD) codes and other identification methods and the performance of the ICD-9 codes alone was not reported. No other studies reported validation data. CONCLUSIONS The lack of data on the validity of algorithms to identify these conditions may hamper our ability to determine incidence patterns with respect to infection and vaccination exposures. Further epidemiologic research to define validated methods of identifying cases could improve surveillance using large linked healthcare databases.
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Affiliation(s)
- Christopher D Lee
- Department of Neurology, Vanderbilt University Medical Center, 1161 21st Ave S, MCN A0118, Nashville, TN 37232, USA.
| | - S Elizabeth Williams
- Vanderbilt Vaccine Research Program, Vanderbilt University Medical Center, 1161 21st Avenue, CCC 5326 Medical Center North, Nashville, TN 37232, USA.
| | - Nila A Sathe
- Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Suite 600, 2525 West End Avenue, Nashville, TN 37203-1738, USA.
| | - Melissa L McPheeters
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Suite 600, 2525 West End Avenue, Nashville, TN 37203-1738, USA.
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