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Alnaqbi KA, Abunamous N, Saleem T. A rare twist: COVID-19 infection masquerading as IgA vasculitis in a hemophilia a patient. Clin Rheumatol 2024; 43:1393-1399. [PMID: 38353792 DOI: 10.1007/s10067-024-06902-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/25/2024] [Accepted: 02/01/2024] [Indexed: 03/19/2024]
Abstract
Hemophilia A and B are one of the most common hereditary bleeding disorders. Patients are predisposed to bleeding spontaneously or after minor trauma in different areas such as the skin, gastrointestinal, or joints. COVID-19 infection has been associated with various clinical manifestations and complications including rarely triggering IgA vasculitis. We report a 23-year-old man who was previously diagnosed with severe hereditary hemophilia A. He presented to our hospital with classic symptoms of IgA vasculitis, complaining of petechiae and purpura in his limbs, fatigue, body aches, poor oral intake, abdominal pain, and watery non-bloody diarrhea. He did not present with respiratory symptoms or fever typical of COVID-19 infection. Abnormal blood tests were mildly elevated C-reactive protein, elevated d-dimers, and low Factor VIII activity. Extensive immunological tests were negative. CT abdomen with contrast was unremarkable. A skin biopsy strongly indicated IgA vasculitis. COVID-19 test came back positive. The patient was managed symptomatically and with glucocorticosteroids which significantly improved his symptoms. The available literature on clinical features, laboratory tests, and management of COVID-19-associated IgA vasculitis is discussed. However, there is no case reported on the associations between hemophilia, COVID-19 infection, and IgA vasculitis. This is the first case of atypical COVID-19 infection masquerading as de novo IgA vasculitis in an adult patient with underlying hemophilia. Our case contributes to the growing body of literature about hemophilia being a possible predisposing factor that a COVID-19 virus relies on to amplify immune dysregulation resulting in IgA vasculitis.
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Affiliation(s)
- Khalid A Alnaqbi
- Division of Rheumatology, Tawam Hospital, P. O. Box 15258, Al Ain, United Arab Emirates.
- Internal Medicine Department, College of Medicine & Health Sciences, UAE University, P. O. Box 1551, Al Ain, United Arab Emirates.
| | | | - Tausif Saleem
- Department of Anatomical Pathology, PureLab, Abu Dhabi, United Arab Emirates
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Fanous N, Clarke E, Levy ML. Posterior reversible encephalopathy syndrome in the setting of IgA vasculitis. Pediatr Dermatol 2024. [PMID: 38368940 DOI: 10.1111/pde.15569] [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: 08/28/2023] [Accepted: 02/03/2024] [Indexed: 02/20/2024]
Abstract
IgA vasculitis (IgAV), formerly known as Henoch-Scholein purpura, is a small vessel vasculitis, most commonly seen in pediatric patients, that can affect numerous internal organs including the kidneys, lungs, gastrointestinal tract, and the central nervous system (CNS). CNS manifestations of this condition include hypertensive encephalopathy, thrombosis, optic neuropathy, seizures, CNS vasculitis, and a more recently described phenomenon known as posterior reversible encephalopathy syndrome (PRES). Symptoms of PRES include hypertension, altered mental status, and seizures caused by vasogenic disruption of the blood-brain barrier, and the condition is diagnosed by characteristic edema-related gray-white matter changes in the parieto-occipital lobes on magnetic resonance imaging. Herein, we present a rare case of PRES as a presenting sign of IgAV to increase awareness about this unusual association.
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Affiliation(s)
- Noah Fanous
- The University of Texas Health Sciences Center at San Antonio, San Antonio, Texas, USA
| | - Emily Clarke
- Division of Dermatology, Dell Medical School at the University of Texas at Austin, Austin, Texas, USA
| | - Moise L Levy
- Division of Dermatology, Dell Medical School at the University of Texas at Austin, Austin, Texas, USA
- Department of Pediatrics, Dell Medical School at the University of Texas at Austin, Austin, Texas, USA
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Stanway J, Brown N, Pervez A, Van de Perre E, Tollitt J, Marketos N, Wong N, Dhaygude A, Ponnusamy A, O'Riordan E, Venning M, Segelmark M, Morgan M, Jayne D, Hamilton P, Pusey CD, Oni L, Salama AD. IgA vasculitis nephritis-outcomes in adult-onset disease. Rheumatology (Oxford) 2024:keae030. [PMID: 38273659 DOI: 10.1093/rheumatology/keae030] [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] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/01/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVES IgA vasculitis (IgAV) in adults has been relatively under-investigated. Since outcomes are worse in other forms of vasculitis with increasing age, we investigated the outcomes of IgAV comparing younger adults (18-34), middle aged adults (35-64) and elderly patients (≥64 years) focusing on kidney outcomes. METHODS We identified patients with renal biopsy confirmed IgAV nephritis and collected data regarding clinical features and progression to end stage kidney disease (ESKD). The relationship between patient factors and ESKD was analysed by regression. RESULTS We identified 202 cases, 34% aged 18-34, 43% aged 35-64 and 23% were elderly (>64 years). Median follow up was 44 months. Elderly patients were more likely to present with ESKD (23.9%) compared with middle aged (13.7%) and younger adults (2.9%)(χ2 11.6, p= 0.002). In patients with independent kidney function at biopsy, there was no difference in outcomes between age groups. Male gender, Black ethnicity, diabetes, histological evidence of chronic renal damage and eGFR < 30mls/min were risk factors for development of ESKD. In this observational study 68.3% of patients received glucocorticoids and 56.9% additional immunosuppression. CONCLUSIONS Elderly patients with IgAV are more likely to have ESKD at presentation, but there is no difference in renal survival between age groups, among those presenting with independent renal function. Renal impairment at biopsy is an independent risk factor for subsequent development of ESKD. There is significant variability in the timing of kidney biopsy and management of these patients among specialist centres. Young adults have outcomes more in keeping with childhood IgAV.
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Affiliation(s)
- James Stanway
- UCL Centre for Nephrology, Royal Free Hospital, London, UK
| | - Nina Brown
- Department of Nephrology, Salford Royal Foundation Trust, Salford, UK
| | - Afeera Pervez
- Department of Nephrology, Queen Elizabeth Hospital, Birmingham, UK
| | - Els Van de Perre
- Vasculitis Clinic, Addenbrookes Hospital, Hills Road, Cambridge, UK
| | - James Tollitt
- Department of Nephrology, Salford Royal Foundation Trust, Salford, UK
| | - Nikolaos Marketos
- Department of Clinical and Experimental Sciences and Department of Rheumatology, Linköping University, Linköping, Sweden
| | - Nikki Wong
- Renal and Vascular Inflammation Section, Imperial College London, London, UK
| | - Ajay Dhaygude
- Department of Nephrology, Royal Preston Hospital, Preston, UK
| | | | - Ed O'Riordan
- Department of Nephrology, Salford Royal Foundation Trust, Salford, UK
| | - Michael Venning
- Manchester Institute of Nephrology & Transplantation, Manchester Royal Infirmary, Manchester, UK
| | - Mårten Segelmark
- Department of Medical and Health Sciences and Department of Nephrology, Linköping University, Linköping, Sweden
| | - Matthew Morgan
- Department of Nephrology, Queen Elizabeth Hospital, Birmingham, UK
| | - David Jayne
- Vasculitis Clinic, Addenbrookes Hospital, Hills Road, Cambridge, UK
| | - Patrick Hamilton
- Manchester Institute of Nephrology & Transplantation, Manchester Royal Infirmary, Manchester, UK
| | - Charles D Pusey
- Renal and Vascular Inflammation Section, Imperial College London, London, UK
| | - Louise Oni
- Division of Nephrology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Alan D Salama
- UCL Centre for Nephrology, Royal Free Hospital, London, UK
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Jiang M, Dai J, Jiang C, Pan Y, Ren M, Xing M. Long noncoding RNA MEG8 induces an imbalance of Th17/Treg cells through the miR-107/STAT3 axis in Henoch-Schonlein purpura rats. Aging (Albany NY) 2023; 15:13854-13864. [PMID: 38054824 PMCID: PMC10756103 DOI: 10.18632/aging.205266] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 10/24/2023] [Indexed: 12/07/2023]
Abstract
T-helper (Th) 17/ T-regulatory (Treg) cell dysregulation underlies the pathogenesis of Henoch-Schonlein purpura (HSP). This research focused on the implication/s of the long noncoding RNA (lncRNAs) maternally expressed gene 8 (MEG8) in Th17 and Treg cell differentiation in HSP rats. MEG8, miR-107, signal transducer and activator of transcription-3 (STAT3), receptor-related orphan receptor γt (RORγt), and the transcription factor forkhead box P3 (Foxp3) expression levels were detected using real-time quantitative polymerase chain reaction and Western blot analyses. Flow cytometry was employed for measuring Th17 and Treg cells within the CD4+ T cell population. The interaction between miR-107 and MEG8 or STAT3 was examined. A low proportion of MEG8 and Treg cells together with Th17 cells were denoted within HSP rats. Moreover, MEG8 overexpression altered the Th17/Treg imbalance in peripheral blood CD4+ T-cell population, and the miR-107 mimic and STAT3 silencing reversed this effect. Thus, MEG8 served as a sponge for miR-107, lowering binding activity to STAT3 and thus overexpressing the molecule. Taken together, MEG8 induces an imbalance of Th17/Treg cells through the miR-107/STAT3 axis in HSP rats.
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Affiliation(s)
- Mingyu Jiang
- Department of Pediatrics, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, P.R. China
| | - Jicheng Dai
- Department of Pediatrics, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, P.R. China
| | - Chunming Jiang
- Department of Neonatology, Zhuhai Women and Children’s Hospital, Zhuhai 519060, P.R. China
| | - Yanbo Pan
- Department of Neurosurgery, Tieling Central Hospital, Tieling 112000, P.R. China
| | - Mingyong Ren
- Department of Pediatrics, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, P.R. China
| | - Mengnan Xing
- Department of Pediatrics, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, P.R. China
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Tang Y, Chen W, Li J, Deng Y, Liu S, Zhou X, Xie J, Zhan C, Li X. A disease-targeted picture book for children with Henoch-Schonlein purpura nephritis: A quasi-experimental study. J Ren Care 2023; 49:243-252. [PMID: 36451338 DOI: 10.1111/jorc.12451] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/14/2022] [Accepted: 11/18/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Children with Henoch-Schonlein purpura nephritis are frequently burdened with psychological problems besides disease treatment and adherence. Currently, there is a shortage of appropriate and effective educational materials to facilitate physical and psychological recovery. OBJECTIVES To examine a picture book for the effectiveness of disease-related knowledge, coping strategies, resilience, quality of life and depressive symptoms in children with Henoch-Schonlein purpura nephritis in China. DESIGN A quasi-experimental design with repeated measures was adopted. The control group received standard care. The intervention group received the standard care plus a free picture book. This disease-specific picture book narrated the story of two rabbits diagnosed with Henoch-Schonlein purpura nephritis who underwent a series of examinations, faced difficulties taking medication, and eventually recovered. PARTICIPANTS The study recruited 60 children diagnosed with Henoch-Schonlein purpura nephritis. MEASUREMENTS Disease-related knowledge, resilience, coping strategies, depression and paediatric quality of life were measured at baseline, the third day, the first month and the third month after recruitment. The acceptability of the picture book was evaluated at the last data-collection point. RESULTS The data showed that children in the intervention group demonstrated higher levels of knowledge (p < 0.001), less usage of emotional coping strategies (p = 0.003), reduced depressive symptoms (p = 0.003), improved psychological resilience (p < 0.001), and better quality of life (p < 0.046) than those in the control group in the third month. Most children (83.3%) in the intervention group were satisfied with the picture book. CONCLUSIONS The targeted picture book is an effective educational tool for improving clinical outcomes and was highly accepted by children.
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Affiliation(s)
- Yao Tang
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China
| | - Weiti Chen
- School of Nursing, University of California, Los Angeles, California, USA
| | - Jingping Li
- Hunan College of Foreign Studies, Changsha, China
| | - Yuqian Deng
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China
| | - Shibo Liu
- Xiangya School of Medicine, Central South University, Changsha, Hunan Province, China
| | - Xia Zhou
- Xiangya Hospital, Central South University, Changsha, China
| | | | - Chaohong Zhan
- Xiangya Hospital, Central South University, Changsha, China
| | - Xianhong Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China
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Si LL, Niu L, Wang XY, Zhang H, Zhang ML, Xu S, Ren XQ, Tang JF, Li WX. [Comparison of distribution of eight components from Liangxue Tuizi Mixture between normal and Henoch-Schonlein purpura rats]. Zhongguo Zhong Yao Za Zhi 2023; 48:5915-5931. [PMID: 38114188 DOI: 10.19540/j.cnki.cjcmm.20230618.202] [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] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
This study used UPLC-TQ-MS technology to replicate a Henoch-Schonlein purpura(HSP) model in rats by administering warm drugs by gavage and injecting ovalbumin with Freund's complete adjuvant emulsion. The distribution differences and characteristics of eight major components(ferulic acid, caffeic acid, neochlorogenic acid, cryptochlorogenic acid, benzoyl oxypaeoniflorin, tracheloside, loganin, and paeoniflorin) in rat liver, lung, heart, spleen, and kidney tissues were determined after oral administration of the Liangxue Tuizi Mixture at a dose of 42 g·kg~(-1) in both normal physiological and HSP states at 0.5, 1, 2, 6, and 12 hours. The results showed that the distribution patterns of the eight components of Liangxue Tuizi Mixture in the tissues of normal and HSP model rats were different. The main component, paeoniflorin, in Moutan Cortex and Paeoniae Radix Alba had higher content in all tissues. The eight components were predominantly distributed in the liver, lung, and kidney tissues, followed by spleen and heart tissues.
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Affiliation(s)
- Li-Ling Si
- School of Pharmacy, Henan University of Chinese Medicine Zhengzhou 450046, China the First Affiliated Hospital of Henan University of Chinese Medicine Zhengzhou 450000, China
| | - Lu Niu
- the First Affiliated Hospital of Henan University of Chinese Medicine Zhengzhou 450000, China
| | - Xiao-Yan Wang
- the First Affiliated Hospital of Henan University of Chinese Medicine Zhengzhou 450000, China Henan Province Engineering Research Center of Clinical Application, Evaluation and Transformation of Traditional Chinese Medicine,Henan Province Engineering Research Center of Safety Evaluation and Risk Management of Traditional Chinese Medicine,Henan Provincial Key Laboratory for Clinical Pharmacy of Traditional Chinese Medicine Zhengzhou 450000, China
| | - Hui Zhang
- the First Affiliated Hospital of Henan University of Chinese Medicine Zhengzhou 450000, China
| | - Ming-Liang Zhang
- the First Affiliated Hospital of Henan University of Chinese Medicine Zhengzhou 450000, China
| | - Shuang Xu
- the First Affiliated Hospital of Henan University of Chinese Medicine Zhengzhou 450000, China School of Pediatrics, Henan University of Chinese Medicine Zhengzhou 450046, China
| | - Xian-Qing Ren
- the First Affiliated Hospital of Henan University of Chinese Medicine Zhengzhou 450000, China School of Pediatrics, Henan University of Chinese Medicine Zhengzhou 450046, China
| | - Jin-Fa Tang
- the First Affiliated Hospital of Henan University of Chinese Medicine Zhengzhou 450000, China Henan Province Engineering Research Center of Clinical Application, Evaluation and Transformation of Traditional Chinese Medicine,Henan Province Engineering Research Center of Safety Evaluation and Risk Management of Traditional Chinese Medicine,Henan Provincial Key Laboratory for Clinical Pharmacy of Traditional Chinese Medicine Zhengzhou 450000, China
| | - Wei-Xia Li
- the First Affiliated Hospital of Henan University of Chinese Medicine Zhengzhou 450000, China Henan Province Engineering Research Center of Clinical Application, Evaluation and Transformation of Traditional Chinese Medicine,Henan Province Engineering Research Center of Safety Evaluation and Risk Management of Traditional Chinese Medicine,Henan Provincial Key Laboratory for Clinical Pharmacy of Traditional Chinese Medicine Zhengzhou 450000, China
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Guo H, Wang ZL, Tao Z. Delayed diagnosis of abdominal Henoch-Schonlein purpura in children: A case report. World J Clin Cases 2023; 11:6311-6317. [PMID: 37731573 PMCID: PMC10507560 DOI: 10.12998/wjcc.v11.i26.6311] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND For children with abdominal Henoch-Schonlein purpura presenting abdominal pain as an initial symptom and severe clinical manifestations, but without purpura appearance on the skin, the diagnosis and treatment are relatively difficult. This study summarized the characteristics of this group of patients by literature review and provided additional references for further refinement of glucocorticoid therapy in this vasculitis. CASE SUMMARY A 6-year-old girl presented mainly with repeated abdominal pain and had received short-term out-of-hospital treatment with hydrocortisone. On day 7 after onset, gastroscopy revealed chronic non-atrophic gastritis and erosive duodenitis without purpuric rash, and no obvious resolution of the abdominal pain was found after treatment against infection and for protection of gastric mucosa. On day 14 the inflammatory indices continued to rise and the pain was relieved after enhanced anti-infective therapy, but without complete resolution. On day 19, the patient presented with aggravated abdominal pain with purplish-red dots on the lower limbs, by which Henoch-Schonlein purpura was confirmed. After 5 d of sequential treatment with methylprednisolone and prednisone, abdominal pain disappeared and she was discharged. CONCLUSION Henoch-Schonlein purpura-related rash may appear after long-term abdominal pain, and should be distinguished from acute and chronic gastrointestinal diseases at the early stage without typical rash. For bacterial infection-induced Henoch-Schonlein purpura, glucocorticoid therapy alone without clearing the infection may not relieve symptoms.
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Affiliation(s)
- Hui Guo
- Department of Pediatrics, West China Second University Hospital, Chengdu 610041, Sichuan Province, China
| | - Zhi-Ling Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu 610000, Sichuan Province, China
| | - Zhu Tao
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu 610000, Sichuan Province, China
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Han X, Xu P. Risk due to Elevated Uric Acid Levels in Children With Henoch-Schonlein Purpura. CLIN INVEST MED 2023; 46:E18-22. [PMID: 37379165 DOI: 10.25011/cim.v46i2.40274] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/07/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE To compare uric acid levels in children with Henoch-Schonlein purpura (HSP)without nephritis and with renal damage, and at different pathological grades. METHODS A total of 451 children were enrolled in this study, including 64 with HSP without nephritis and 387 HSP with kidney damage. Age, gender, uric acid, urea, creatinine and cystatin C levels were reviewed. Pathological findings of those with renal impairment were also reviewed. RESULTS Among the HSP children with renal damage, 44 were grade I, 167 were grade II and 176 were grade III. There were significant differences in age, uric acid, urea, creatinine and cystatin C levels between the two groups (p<0.05, all). Correlation analysis showed that uric acid levels in children with HSP without nephritis were positively correlated with urea and creatinine levels (p<0.05). Uric acid levels in HSP children with renal damage was positively correlated with age, urea, creatinine and cystatin C levels (p<0.05, all). Regression analysis found that, without adding any correction factors, there were significant differences in uric acid levels between the two groups; however, after adjusting for pathological grade, there was no longer a significant difference. CONCLUSIONS There were significant differences of uric acid levels in children with HSP without nephritis and with renal impairment. Uric acid levels in the renal impairment group were significantly higher than that in the HSP without nephritis group. Uric acid levels were related to only the presence or absence of renal damage, not to the pathological grade.
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Affiliation(s)
- Xiucui Han
- Department of Clinical Laboratory, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, PR China
| | - Pengfei Xu
- Clinical Laboratory, Zhejiang Hospital, Hangzhou, PR China.
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Xie Y, Deng Q, Guo M, Li X, Xian D, Zhong J. Proanthocyanidins: A novel approach to Henoch‑Schonlein purpura through balancing immunity and arresting oxidative stress via TLR4/MyD88/NF‑κB signaling pathway (Review). Exp Ther Med 2023; 25:300. [PMID: 37229322 PMCID: PMC10203752 DOI: 10.3892/etm.2023.11999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 04/04/2023] [Indexed: 05/27/2023] Open
Abstract
Henoch-Schonlein purpura (HSP), a recurrent and immunoglobulin (Ig)A-mediated vasculitis, presents not only as skin lesions but also as systemic involvement that can be life-threatening. Although the etiology of HSP remains unknown, immune imbalance and oxidative stress (OS) are primary contributors to its pathogenesis, alongside the abnormal activation of Toll-like receptor (TLR)/myeloid differentiation primary response gene 88 (MyD88)/nuclear factor-κB (NF-κB) pathway. TLRs, especially TLR4, stimulate downstream signaling molecules such as NF-κB and proinflammatory cytokines, which are released when TLRs combine with the key adapter molecule MyD88. This leads to the activation of T helper (Th) cell 2/Th17 and overproduction of reactive oxygen species (ROS). The function of regulatory T (Treg) cells is suppressed in the process. Th17/Treg imbalance then produces various inflammatory cytokines to promote proliferation and differentiation of B cells and the secretion of antibodies. IgA is secreted, and it binds to vascular endothelial surface receptors where the complex induces injury of the vascular endothelial cells. Additionally, excessive ROS creates OS that leads to an inflammatory response and vascular cell apoptosis or necrosis, thereby contributing to vascular endothelial damage and HSP occurrence. Proanthocyanidins are active compounds naturally enriched in fruits, vegetables and plants. Proanthocyanidins have diverse properties, including anti-inflammatory, antioxidant, antibacterial, immunoregulatory, anticarcinogenic and vascular protective effects. Proanthocyanidins are used in the management of various diseases. Proanthocyanidins regulate T cells, equilibrate immunity and arrest OS by inhibiting the TLR4/MyD88/NF-κB signaling pathway. Considering the pathogenesis of HSP and the properties of proanthocyanidins, the present study hypothesized that these compounds may potentially lead to HSP recovery through modulating the immune equilibrium and preventing OS by inhibiting the TLR4/MyD88/NF-κB pathway. To the best of our knowledge, however, little is known about the positive effects of proanthocyanidins against HSP. The present review summarizes the potential of proanthocyanidins to treat HSP.
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Affiliation(s)
- Yuxin Xie
- Department of Dermatology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Qiyan Deng
- Department of Dermatology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Menglu Guo
- Department of Dermatology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Xiaolong Li
- Department of Dermatology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Deihai Xian
- Department of Neurobiology, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Jianqiao Zhong
- Department of Dermatology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
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Kifer N, Bulimbasic S, Sestan M, Held M, Kifer D, Srsen S, Gudelj Gracanin A, Heshin-Bekenstein M, Giani T, Cimaz R, Gagro A, Frković M, Coric M, Jelusic M. Semiquantitative classification (SQC) and Oxford classifications predict poor renal outcome better than The International Study of Kidney Disease in Children (ISKDC) and Haas in patients with IgAV nephritis: a multicenter study. J Nephrol 2023; 36:441-449. [PMID: 36447124 DOI: 10.1007/s40620-022-01509-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/19/2022] [Indexed: 12/07/2022]
Abstract
INTRODUCTION Several histologic classifications are used in the evaluation of IgA vasculitis nephritis (IgAVN), however, to date, no studies have determined which one has the strongest association with the severity of IgAVN and, as a consequence, its outcomes. MATERIALS AND METHODS Patients included in the study were diagnosed with IgAV and IgAVN in seven tertiary university medical centers in Croatia, Italy and Israel. The International Study of Kidney Disease in Children (ISKDC), Haas, Oxford, and Semiquantitative classification (SQC) classifications were used in the analysis and description of renal biopsy. Time from biopsy to outcome evaluation was a statistically significant factor in outcome prediction that was used to define the base model, and was a covariate in all the tested models. RESULTS Sixty-seven patients were included in this study. The SQC classification proved to be the best one in outcome prediction, followed by the Oxford classification. The ISKDC and Haas classifications could not predict renal outcome. The Oxford parameters for mesangial hypercellularity and tubular atrophy, as well as the SQC parameters for cellular crescents showed an independent statistically significant contribution to outcome prediction. High level of twenty-four hour protein excretion was associated with a higher grade in the Oxford, SQC and ISKDC classifications. Endocapillary proliferation was positively associated with the Pediatric Vasculitis Activity Score (PVAS) at diagnosis, while tubular atrophy was negatively associated. CONCLUSION The SQC, followed by the Oxford classification were found to provide the best classifications of renal biopsy analysis in patients to predict the outcome in patients with IgAVN. Cellular crescents, mesangial hypercellularity and tubular atrophy showed significant contributions, indicating that active and chronic variables should be included in the estimation.
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Affiliation(s)
- Nastasia Kifer
- Division of Rheumatology and Immunology, Department of Pediatrics, Referral Centre for Pediatric and Adolescent Rheumatology Republic of Croatia, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Stela Bulimbasic
- Department of Pathology and Cytology, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mario Sestan
- Division of Rheumatology and Immunology, Department of Pediatrics, Referral Centre for Pediatric and Adolescent Rheumatology Republic of Croatia, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Martina Held
- Division of Rheumatology and Immunology, Department of Pediatrics, Referral Centre for Pediatric and Adolescent Rheumatology Republic of Croatia, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Domagoj Kifer
- Department of Biophysics, University of Zagreb Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Sasa Srsen
- Division of Rheumatology and Immunology, Department of Paediatrics, University of Split School of Medicine, University Hospital Centre Split, Split, Croatia
| | - Ana Gudelj Gracanin
- Department of Internal Medicine, Clinical Hospital Holly Spirit, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Merav Heshin-Bekenstein
- Pediatric Rheumatology Service, Dana Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Teresa Giani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Rolando Cimaz
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- ASST Pini-CTO, Milan, Italy
| | - Alenka Gagro
- Children's Hospital Zagreb, University of Osijek, Medical Faculty Osijek, Osijek, Croatia
| | - Marijan Frković
- Division of Rheumatology and Immunology, Department of Pediatrics, Referral Centre for Pediatric and Adolescent Rheumatology Republic of Croatia, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Marijana Coric
- Department of Pathology and Cytology, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marija Jelusic
- Division of Rheumatology and Immunology, Department of Pediatrics, Referral Centre for Pediatric and Adolescent Rheumatology Republic of Croatia, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
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11
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Dong W, Wu S, Zhou J. A rare association of invasive infective endocarditis due to Abiotrophia defectiva with ventricular septal defect and recurrent Henoch-Schonlein purpura in a child. J Cardiothorac Surg 2022; 17:320. [PMID: 36528593 PMCID: PMC9758810 DOI: 10.1186/s13019-022-02092-2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Henoch-Schonlein purpura is the most common vasculitis in childhood, usually triggered by an upper respiratory tract infection and rarely observed in infective endocarditis patients. Abiotrophia defectiva is a rare causative agent of infective endocarditis associated with pre-existing heart disease, immunocompromised and prosthetic valves. Dental procedures are also a common predisposing factor. CASE PRESENTATION We present the first pediatric congenital heart disease case of infective endocarditis caused by Abiotrophia defectiva combined with recurrent Henoch-Schonlein purpura. A 10-year-old girl with uncorrected congenital heart defects and Henoch-Schonlein purpura developed a purple petechial rash again. Transthoracic echocardiography evaluation revealed multiple irregular vegetations on the right ventricular side of the ventricular septal defect and on the tricuspid valve leaflets. Blood cultures grew Abiotrophia defectiva. The girl received cardiac surgery for vegetation resection as well as congenital heart defect correction and tricuspid valve replacement. Five months after the surgery, the patient was in satisfactory condition without any signs of endocarditis or valve insufficiency and her purpuric rash disappeared. CONCLUSIONS The coexistence of recurrent Henoch-Schonlein purpura and infective endocarditis is possible. Abiotrophia defectiva belongs to the streptococcus with a high virulence. In addition, cardiovascular surgery is often required for pediatric infective endocarditis associated with Abiotrophia defectiva, and bioprosthetic valve replacement is considered feasible for irreparable tricuspid valve in children.
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Affiliation(s)
- Wenpeng Dong
- grid.412679.f0000 0004 1771 3402Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Shushan District, Hefei, 230032 China
| | - Shuibi Wu
- grid.412679.f0000 0004 1771 3402Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Shushan District, Hefei, 230032 China
| | - Jing Zhou
- grid.460068.c0000 0004 1757 9645Department of Cardiovascular Surgery, The Third People’s Hospital of Chengdu, Chengdu, China
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12
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Ramdani Y, Galempoix JM, Augusto JF, Dekmeer E, Perard L, Ferreira N, Bigot A, Magnant J, Jobard S, Diot E, Besse MC, Henrique H, Maillot F, Audemard-Verger A. Immunoglobulin A Vasculitis Following COVID-19: A French Multicenter Case Series. J Rheumatol 2022; 49:1390-1394. [PMID: 36243405 DOI: 10.3899/jrheum.220503] [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] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Immunoglobulin A vasculitis (IgAV) usually occurs following viral respiratory tract infection. In the context of the global coronavirus disease 2019 (COVID-19) pandemic, we describe a case series of patients who developed IgAV following SARS-CoV-2 infection. METHODS This national multicenter retrospective study included patients with IgAV following SARS-CoV-2 infection from January 1, 2020, to January 1, 2022. Patients had histologically proven IgAV and reverse transcription PCR (RT-PCR)-proven SARS-CoV-2 infection. The interval between infection and vasculitis onset had to be < 4 weeks. RESULTS We included 5 patients, 4 of whom were women with a mean age of 45 years. Four patients had paucisymptomatic infections and 1 required a 48-hour low-flow oxygen treatment. All 5 patients had purpuric skin involvement. Arthritis was observed in 2 patients, 3 had IgA glomerulonephritis, and 2 had digestive involvement. Three renal biopsies were performed and showed mesangial IgA deposits without any extracapillary proliferation. Median C-reactive protein was 180 (range 15.1-225) mg/L, median serum creatinine level was 65 (range 41-169) µmol/L, and 2 patients had a glomerular filtration rate < 60 mL/min. Four patients received first-line treatment with glucocorticoids. All patients had a favorable progression and 2 patients experienced minor skin relapses, one after COVID-19 vaccination. CONCLUSION This series describes the emergence of IgAV closely following COVID-19; we were not able to eliminate an incidental link between these events. Their disease outcomes were favorable. In most of our patients, the SARS-CoV-2 infection was paucisymptomatic, and we recommend RT-PCR tests to look for COVID-19 in patients without any evident triggers for IgAV.
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Affiliation(s)
- Yanis Ramdani
- Y. Ramdani, MD, F. Maillot, MD, PhD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, University Hospital of Tours, and University of Tours, Tours
| | - Jean Marc Galempoix
- J.M. Galempoix, MD, Department of Internal Medicine, Nord Ardennes Hospital, Charleville-Mézières
| | | | - Eva Dekmeer
- E. Dekmeer, MD, Department of Dermatology, Archet University Hospital, Nice
| | - Laurent Perard
- L. Perard, MD, Department of Internal Medicine, St Joseph-St Luc Hospital, Lyon
| | - Nicole Ferreira
- N. Ferreira, MD, A. Bigot, MD, J. Magnant, MD, S. Jobard, MD, E. Diot, MD, PhD, M.C. Besse, MD, H. Henrique, MD, Department of Internal Medicine and Clinical Immunology, University Hospital of Tours, Tours, France
| | - Adrien Bigot
- N. Ferreira, MD, A. Bigot, MD, J. Magnant, MD, S. Jobard, MD, E. Diot, MD, PhD, M.C. Besse, MD, H. Henrique, MD, Department of Internal Medicine and Clinical Immunology, University Hospital of Tours, Tours, France
| | - Julie Magnant
- N. Ferreira, MD, A. Bigot, MD, J. Magnant, MD, S. Jobard, MD, E. Diot, MD, PhD, M.C. Besse, MD, H. Henrique, MD, Department of Internal Medicine and Clinical Immunology, University Hospital of Tours, Tours, France
| | - Stéphanie Jobard
- N. Ferreira, MD, A. Bigot, MD, J. Magnant, MD, S. Jobard, MD, E. Diot, MD, PhD, M.C. Besse, MD, H. Henrique, MD, Department of Internal Medicine and Clinical Immunology, University Hospital of Tours, Tours, France
| | - Elisabeth Diot
- N. Ferreira, MD, A. Bigot, MD, J. Magnant, MD, S. Jobard, MD, E. Diot, MD, PhD, M.C. Besse, MD, H. Henrique, MD, Department of Internal Medicine and Clinical Immunology, University Hospital of Tours, Tours, France
| | - Marie Charlotte Besse
- N. Ferreira, MD, A. Bigot, MD, J. Magnant, MD, S. Jobard, MD, E. Diot, MD, PhD, M.C. Besse, MD, H. Henrique, MD, Department of Internal Medicine and Clinical Immunology, University Hospital of Tours, Tours, France
| | - Hélène Henrique
- N. Ferreira, MD, A. Bigot, MD, J. Magnant, MD, S. Jobard, MD, E. Diot, MD, PhD, M.C. Besse, MD, H. Henrique, MD, Department of Internal Medicine and Clinical Immunology, University Hospital of Tours, Tours, France
| | - François Maillot
- Y. Ramdani, MD, F. Maillot, MD, PhD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, University Hospital of Tours, and University of Tours, Tours
| | - Alexandra Audemard-Verger
- Y. Ramdani, MD, F. Maillot, MD, PhD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, University Hospital of Tours, and University of Tours, Tours
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13
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Zhan Y, Wu M, Li K, Chen Q, Li N, Zheng W, Zhu Y, Peng X, Zhang S, Tao Q. Development and Validation of a Differential Diagnosis Model for Acute Appendicitis and Henoch-Schonlein Purpura in Children. Pediatr Allergy Immunol Pulmonol 2022; 35:86-94. [PMID: 35723658 DOI: 10.1089/ped.2021.0218] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: To study and develop a predictive model for the differential diagnosis of acute appendicitis (AA) and Henoch-Schonlein purpura (HSP) in children and to validate the model internally and externally. Methods: The complete data of AA and HSP cases were retrospectively analyzed and divided into internal and external verification groups. SPSS software was used for single-factor analysis and screening of independent variables, and R software was used for the development and verification of the diagnostic model. Lasso regression analysis was used to screen predictors and Lasso-logistic regression model was constructed, and K-fold cross-validation was used for the internal verification. In addition, nonfever patients were selected for model development and validation in the same way. Receiver operating characteristic (ROC) curves and calibration curves were drawn, respectively, to evaluate the 2 models. Results: Internal development and validation of the model showed that fever, neutrophil ratio (NEUT%), albumin (ALB), direct bilirubin (DBIL), C-reactive protein (CRP), and K were predictive factors for the diagnosis of HSP. The model was presented in the form of a nomogram, and the area under ROC curve of the development group and verification group was 0.9462 (95% confidence interval [CI] = 0.9402-0.9522) and 0.8931 (95% CI = 0.8724-0.9139), respectively. In the model of patients without fever, NEUT%, platelets (PLT), ALB, DBIL, alkaline phosphatase (ALP), CRP, and K were predictive factors for the diagnosis of HSP, and the area under ROC curve of the development group and verification group was 0.9186 (95% CI = 0.908-0.9293) and 0.8591 (95% CI = 0.8284-0.8897), respectively. Conclusion: In this study, 2 diagnostic models were constructed for fever or not, both of which had good discrimination and calibration, and were helpful to distinguish AA and HSP in children.
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Affiliation(s)
- Yishan Zhan
- Department of General Surgery, Affiliated Children's Hospital of Nanchang University, Nanchang, China.,Department of Pediatric Intensive Care Unit, Affiliated Children's Hospital of Nanchang University, Nanchang, China
| | - Min Wu
- Department of General Surgery, Affiliated Children's Hospital of Nanchang University, Nanchang, China
| | - Kehao Li
- Department of General Surgery, Affiliated Children's Hospital of Nanchang University, Nanchang, China
| | - Qiang Chen
- Department of Pediatric Intensive Care Unit, Affiliated Children's Hospital of Nanchang University, Nanchang, China
| | - Nuoya Li
- Department of General Surgery, Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Weiming Zheng
- Department of Nephrology, Affiliated Children's Hospital of Nanchang University, Nanchang, China
| | - Yourong Zhu
- Department of Pediatric Intensive Care Unit, Affiliated Children's Hospital of Nanchang University, Nanchang, China
| | - Xiaojie Peng
- Department of Nephrology, Affiliated Children's Hospital of Nanchang University, Nanchang, China
| | - Shouhua Zhang
- Department of General Surgery, Affiliated Children's Hospital of Nanchang University, Nanchang, China.,Department of General Surgery, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Qiang Tao
- Department of General Surgery, Affiliated Children's Hospital of Nanchang University, Nanchang, China.,Department of General Surgery, Jiangxi Provincial Children's Hospital, Nanchang, China
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Zhang L, Lin Q, Jiang L, Wu M, Huang L, Quan W, Li X. Increased circulating innate lymphoid cell (ILC)1 and decreased circulating ILC3 are involved in the pathogenesis of Henoch-Schonlein purpura. BMC Pediatr 2022; 22:201. [PMID: 35413831 PMCID: PMC9003988 DOI: 10.1186/s12887-022-03262-w] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 04/01/2022] [Indexed: 11/30/2022] Open
Abstract
Background Innate lymphoid cell (ILC) dysfunction is involved in numerous immune diseases, but this has not been demonstrated in Henoch-Schonlein purpura (HSP). This study aimed to investigate whether ILC dysfunction or imbalance participate in the pathogenesis of HSP. Methods This was a prospective study in patients with HSP who were hospitalized at the Children’s Hospital of Soochow University from June to December 2019. Age- and sex-matched controls were also enrolled. ILC subsets and lymphocyte subpopulations were determined by flow cytometry. The transmission immune turbidimetric method also facilitated the exploration of correlations between ILC subset frequency and lymphocyte subpopulation, as well as serum IgA in HSP patients. Results Fifty-one patients with HSP and 22 control patients were included. There were no differences in age and sex between the two groups. Compared with controls, patients with HSP had higher ILCs in relation to lymphocytes (P = 0.036), higher ILCs in relation to PBMCs (P = 0.026), higher ILC1s (P < 0.001), lower ILC3s (P < 0.05), and higher ILC1/ILC3 ratio (P < 0.001). Sixteen patients underwent routine therapy combined with methylprednisolone for 7–10 days; ILC1s were significantly decreased (P < 0.001) and ILC3s were increased (P = 0.033), and ILC1/ILC3 was significantly decreased (P < 0.001). Compared with the controls, the ratios of ILCs/lymphocytes and ILCs/PBMC were higher in patients in the arthritis and mixed groups (all P < 0.05). ILC1 were elevated in the purpura, arthritis, abdominal, and mixed groups (P = 0.027, P = 0.007, P < 0.001, and P < 0.001, respectively). ILC1/ILCs were positively correlated with CD3 + CD8 + T lymphocytes (r = 0.3701, P = 0.0075). The level of IgA did not correlate with ILCs. Conclusions Higher circulating ILC1s and lower circulating ILC3s appear to be involved in the pathogenesis of HSP. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03262-w.
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Affiliation(s)
- Lili Zhang
- Department of Nephrology, Children's Hospital of Soochow University, No. 92, Zhong Nan Street, Industrial Park, Suzhou, 215003, Jiangsu, China.,Department of Pediatrics, Affiliated Hospital of Yangzhou University, Yangzhou, 225000, Jiangsu, China
| | - Qiang Lin
- Department of Nephrology, Children's Hospital of Soochow University, No. 92, Zhong Nan Street, Industrial Park, Suzhou, 215003, Jiangsu, China
| | - Lijun Jiang
- Department of Neonatology, Affiliated Hospital of Yangzhou University, Yangzhou, 225000, Jiangsu, China
| | - Mingfu Wu
- Department of Neonatology, Affiliated Hospital of Yangzhou University, Yangzhou, 225000, Jiangsu, China
| | - Linlin Huang
- Department of Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, 215003, Jiangsu, China
| | - Wei Quan
- Department of Nephrology, Children's Hospital of Soochow University, No. 92, Zhong Nan Street, Industrial Park, Suzhou, 215003, Jiangsu, China
| | - Xiaozhong Li
- Department of Nephrology, Children's Hospital of Soochow University, No. 92, Zhong Nan Street, Industrial Park, Suzhou, 215003, Jiangsu, China.
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15
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Li C, Wang ZB. Clinical application of compound Glycyrrhizin tablets in the treatment of patients with Simplex Henoch-Schonlein Purpura and its effect on immune function. Pak J Med Sci 2022; 38:271-275. [PMID: 35035438 PMCID: PMC8713233 DOI: 10.12669/pjms.38.1.4609] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/27/2021] [Accepted: 09/08/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives: To investigate the curative effect of Compound Glycyrrhizin Tablets in the adjuvant treatment of simplex Henoch-Schonlein purpura and its influence in improving immune function. Methods: In this retrospective study design was used in this study. Eighty newly diagnosed patients with purpura simplex who visited the outpatient department of Baoding First Central Hospital from June 2017 to February 2020 were included. They were randomly divided into treatment group and control group. The two groups were provided with the same conventional comprehensive treatment. Patients in the treatment group received oral administration of Compound Glycyrrhizin Tablets on the basis of conventional treatment. The clinical efficacy of the treatment group and the control group were compared according to the time and effect of purpura regression, followed by the comparison of changes of T cell subsets before and after treatment. Results: The total effective rate of the treatment group was 92.5%, which was higher than that of the control group (77.5%) (P < 0.05). The purpura subsidence time of effective patients in treatment group was shorter than that in control group (P < 0.05). There was no significant difference in lymphocyte subsets between the treatment group and the control group before treatment. After treatment, the proportion of CD4+ cells and CD4+/CD8+ cells in the treatment group were obviously higher than that in the control group, and the count of CD8+ cells was evidently lower than that in the control group (P < 0.05). Conclusions: Compound Glycyrrhizin is effective in the adjuvant treatment of simplex Henoch-Schonlein purpura without obvious adverse reactions, which is valuable for clinical application as an adjuvant.
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Affiliation(s)
- Chao Li
- Chao Li, Department of Hematology, Beijing Aerospace General Hospital, Beijing, 100076, P.R. China
| | - Zhi-Bin Wang
- Zhi-bin Wang2 Department of Hematology, Baoding First Central Hospital, Baoding, Hebei, 071000, P.R.China
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16
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Hu HB, Wu JG, Cheng Y, Li JJ. Epidemiology and Clinical Characteristics of Henoch-Schönlein Purpura Associated with Epstein-Barr Virus Infection. Mediterr J Hematol Infect Dis 2021; 13:e2021064. [PMID: 34804438 DOI: 10.4084/MJHID.2021.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/16/2021] [Indexed: 11/08/2022] Open
Abstract
Background Henoch-Schönlein purpura (HSP) is an immune-mediated vasculitis, and the formation of immune complexes may be triggered by exposure to Epstein-Barr virus (EBV) infection. Methods We performed a five-year case-control study to evaluate the epidemiology and clinical characteristics of HSP associated with EBV infection. Results The incidence of EBV-triggered HSP was 4.2%, while EBV infection in children with HSP was 0.9%; The EBV-triggered HSP cases had a significantly higher frequency of abdominal pain than the Mycoplasma Pneumoniae (MP)-triggered HSP group (χ2 = 8.024, p = 0.005); Significant differences were observed in the duration of abdominal pain (Z = -1.935, p = 0.027) between the two groups; C3 (t = 9.709, p < 0.001), IgA (t = 20.39, p < 0.001) and IgG (t = 6.407, p < 0.001) were significantly increased in the EBV infection group than those in the healthy control group. Notably, significantly higher proportion of CD19 (t = 6.773, p < 0.001) and lower proportion of CD56 (t = 11.13, p < 0.001) was found in EBV infection group compared with healthy control group. The IgA level was higher than that of the non-infectious group (t = 2.162, p = 0.032), but their CD4/CD8 ratio (t = 10.070, p < 0.001) and CD56 proportion (t = 2.096, p = 0.037) were significantly lower. Conclusions Both cellular and humoral immunity were involved in the pathogenesis of EBV-triggered HSP, leading to increased production of inflammatory mediators and immunoglobulins. Those events may cause or promote the development of systemic vessel vasculitis.
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Zhang N, Tian G, Sun Y, Pan J, Xu W, Li Z. Altered B cell compartment associated with Tfh cells in children with Henoch-Schonlein Purpura. BMC Pediatr 2021; 21:399. [PMID: 34517873 PMCID: PMC8436472 DOI: 10.1186/s12887-021-02873-z] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/02/2021] [Indexed: 11/10/2022] Open
Abstract
AIM IgA-producing B cells have been found to be associated with children diagnosed with Henoch-Schonlein purpura (HSP). The aim of the present study was to determine whether children with HSP possess altered B-cell subsets. METHODS A total of 14 children diagnosed with HSP and age- and sex-matched healthy controls (HCs) were enrolled in our study. Peripheral blood mononuclear cells were isolated, and the percentage and absolute number of B-cell subsets and Follicular helper T (Tfh) cells were determined by flow cytometry. Finally, Spearman's correlation coefficient was used to analyse the correlation between the percentage of Tfh cells and B-cell subsets. RESULTS We found that compared to HCs, the frequency and absolute number of total B cells were significantly higher in children with HSP, but the percentages of plasma cells and naïve B cells were significantly lower. A significantly increased percentage and absolute number of memory nonswitched B cells were found in children with HSP compared with HCs. We observed that the expression of C-X-C chemokine receptor type 5 (CXCR5) on total CD4+ T cells and the percentage of CD4+CXCR5+ cells were significantly increased in patients with HSP. Moreover, significantly correlations between Tfh cells and various B-cell subsets were observed. CONCLUSIONS Our study showed a Tfh-cell-associated altered B cell compartment in children with HSP.
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Affiliation(s)
- Ning Zhang
- Department of Hematology, The First Affiliated Hospital of Jinzhou Medical University, No.2 Renmin Street, Liaoning, 121000, Jinzhou, People's Republic of China.
| | - Ge Tian
- Department of Hematology, The First Affiliated Hospital of Jinzhou Medical University, No.2 Renmin Street, Liaoning, 121000, Jinzhou, People's Republic of China
| | - Yuanyuan Sun
- Department of Hematology, The First Affiliated Hospital of Jinzhou Medical University, No.2 Renmin Street, Liaoning, 121000, Jinzhou, People's Republic of China
| | - Jing Pan
- Department of Hematology, The First Affiliated Hospital of Jinzhou Medical University, No.2 Renmin Street, Liaoning, 121000, Jinzhou, People's Republic of China
| | - Wei Xu
- Department of Hematology, The First Affiliated Hospital of Jinzhou Medical University, No.2 Renmin Street, Liaoning, 121000, Jinzhou, People's Republic of China
| | - Zhe Li
- Department of Hematology, The First Affiliated Hospital of Jinzhou Medical University, No.2 Renmin Street, Liaoning, 121000, Jinzhou, People's Republic of China.
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Li J, Chen M, Wang J, Lu L, Li X, Le Y. MicroRNA profiling in Chinese children with Henoch-Schonlein purpura and association between selected microRNAs and inflammatory biomarkers. Acta Paediatr 2021; 110:2221-2229. [PMID: 33533510 DOI: 10.1111/apa.15789] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/10/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 12/22/2022]
Abstract
AIM This study aimed to profile the microRNA levels in Chinese Henoch-Schonlein purpura (HSP) children and to explore their association with inflammatory factors and T helper 17 (Th17)/regulatory T (Treg). METHODS Forty-five HSP children and 27 healthy controls were enrolled in this study, and microRNA levels were profiled with a microRNA microarray. The levels of selected microRNAs were determined by quantitative real-time PCR, and the levels of serum IgA, interleukin-6, interleukin-10 and interleukin-17A were detected by enzyme-linked immunosorbent assay. Additionally, Th17 and Treg cells were analysed by flow cytometry. RESULTS There were 9 up-regulated and 27 down-regulated microRNAs in the PBMCs of Chinese HSP children. Among them, miR-1-3p, miR-19b-1-5p and miR-29b-1-5p were up-regulated, while miR-483-5p and miR-1246 were down-regulated. Additionally, these selected microRNAs could differentiate HSP patients from healthy controls. Interestingly, miR-29b-1-5p was correlated with IgA, miR-19b-1-5p, miR-483-5p and miR-1246 were correlated with interleukin-6, while miR-1-3p and miR-1246 were correlated with Th17/Treg. CONCLUSION This study reveals that the altered microRNAs could differentiate HSP from the healthy, and were associated with inflammatory factors or Th17/Treg. It is indicated that alteration in these microRNAs may contribute to the HSP pathogenesis and may become therapeutic targets or diagnostic biomarkers for HSP.
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Affiliation(s)
- Jing Li
- Department of Pediatrics The First Affiliated Hospital of Jinzhou Medical University Jinzhou China
| | - Meixue Chen
- Department of Pediatrics The First Affiliated Hospital of Jinzhou Medical University Jinzhou China
| | - Jinfeng Wang
- Department of Pediatrics The First Affiliated Hospital of Jinzhou Medical University Jinzhou China
| | - Lingling Lu
- Department of Pediatrics The First Affiliated Hospital of Jinzhou Medical University Jinzhou China
| | - Xiang Li
- Department of Pediatrics The First Affiliated Hospital of Jinzhou Medical University Jinzhou China
| | - Yuan Le
- Department of Pediatrics The First Affiliated Hospital of Jinzhou Medical University Jinzhou China
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Fu W, Ye W, Liu X, Zhu S, Fu H, Zhu R, Li H, Zeng H, Wang Q. Meta-analysis of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in Henoch-Schonlein purpura and its complications. Int Immunopharmacol 2021; 94:107454. [PMID: 33588173 DOI: 10.1016/j.intimp.2021.107454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/09/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are associated with the severity of Henoch-Schonlein purpura (HSP). Therefore, we conducted a meta-analysis to evaluate the clinical significance of NLR and PLR in HSP and its complications. METHODS A comprehensive literature search was conducted by searching the PubMed, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang, VIP, and SinoMed databases from their inception to September 31, 2020. We used the standard mean difference (SMD) with a 95% confidence interval (CI) to estimate the pooled effect and used subgroup analysis to investigate heterogeneity. RESULTS A total of 1,691 HSP patients and 563 healthy controls (HCs) from 15 studies were included in the analysis. The NLR value was significantly higher in 431 HSP patients with gastrointestinal complications (HSP-GCs) than that in 833 HSP patients without GCs (SMD = 1.09, 95% CI: 0.62-1.57, P < 0.001); in 83 HSP adult patients with renal involvement (HSP-RI) than that in 131 adult HSP patients without RI (SMD = 0.33, 95% CI: 0.05-0.60, P = 0.021); and in 831 HSP patients than that in 563 HCs (SMD = 0.70, 95% CI: 0.51-0.89, P < 0.001). The PLR was significantly higher in 417 HSP patients than that in 264 HCs (SMD = 0.39, 95% CI: 0.06-0.71, P = 0.02). CONCLUSIONS NLR could serve as a useful biomarker to predict GCs and RI in patients with HSP. However, further well-designed and large cohort studies are warranted to confirm these findings.
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Affiliation(s)
- Wei Fu
- Clinical Medicine, Senior Students from the Southwest Medical University, Luzhou 646000, Sichuan, PR China
| | - Weixia Ye
- Department of Gastroenterology, Luzhou People's Hospital, Luzhou 646000, Sichuan, PR China
| | - Xianqiang Liu
- Clinical Medicine, Senior Students from the Southwest Medical University, Luzhou 646000, Sichuan, PR China
| | - Sirui Zhu
- Clinical Medicine, Senior Students from the Southwest Medical University, Luzhou 646000, Sichuan, PR China
| | - Hu Fu
- Department of Laboratory Medicine, Chengdu First People's Hospital, Chengdu 610000, Sichuan, PR China
| | - Rui Zhu
- Clinical Medicine, Senior Students from the Southwest Medical University, Luzhou 646000, Sichuan, PR China
| | - Hongmin Li
- Clinical Medicine, Senior Students from the Southwest Medical University, Luzhou 646000, Sichuan, PR China
| | - Haoyun Zeng
- Clinical Medicine, Senior Students from the Southwest Medical University, Luzhou 646000, Sichuan, PR China
| | - Qin Wang
- Sichuan Provincial Center for Gynecology and Breast Diseases, Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, PR China.
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Dundar HA, Pektanc M, Bayram MT, Soylu A, Kavukcu S. Obesity is associated with severe clinical course in children with Henoch-Schonlein purpura. Pediatr Nephrol 2020; 35:2327-33. [PMID: 32613276 DOI: 10.1007/s00467-020-04672-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/17/2020] [Accepted: 06/11/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND We aimed to evaluate the role of obesity on the clinical course and response to treatment in patients with Henoch-Schonlein purpura (HSP). METHODS Data charts of children with HSP followed in a tertiary hospital between 2000 and 2018 were reviewed retrospectively. Persistent purpura was defined as skin involvement persisting for ≥ 30 days. Mild nephropathy was defined as the presence of microscopical hematuria and/or non-nephrotic proteinuria, while severe nephropathy as nephrotic proteinuria, nephritic syndrome, and/or kidney insufficiency. Obese and non-obese patients were compared for demographic, clinical, and laboratory parameters. RESULTS There were 199 patients (M/F, 104/95; median (IQR) presenting age 7.1 (5.0-9.2) years; follow-up period 17.5 (6-50) months). Obese patients (n = 35 (17.6%)) had significantly higher rate of persistent purpura (46% vs 21%), severe renal involvement (58% vs 31%), high-grade renal histopathological lesions (83% vs 39%), hypertension (29% vs 9%), and increased erythrocyte sedimentation rate (79% vs 56%). Obese patients also showed delayed improvement of cutaneous (25 vs 14 days), articular (12.5 vs 10.0 days), and kidney (280 vs 57 days) symptoms. Obese children used steroids for significantly longer period of time (236 vs 40 days). Furthermore, need for immunosuppressive medications were higher in obese patients (40% vs 9%). CONCLUSIONS Obese children with HSP had higher erythrocyte sedimentation rate, hypertension, and severe renal involvement; showed delayed improvement of skin, joint, and kidney findings; and need more immunosuppressive medications and a longer period of steroid treatment. These findings may be associated with the effect of adipose tissue on inflammation.
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Javadi Parvaneh V, Shirzani A, Rahmani K, Shiari R. Pediatric Granulomatosis With Polyangiitis Mimicking IgA Vasculitis: A Case Report. Clin Med Insights Arthritis Musculoskelet Disord 2020; 13:1179544120967371. [PMID: 33223861 PMCID: PMC7649873 DOI: 10.1177/1179544120967371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/22/2020] [Indexed: 11/16/2022]
Abstract
Background Granulomatosis with polyangiitis (GPA) is a systemic vasculitis of the upper and lower respiratory tract along with glomerulonephritis and is very rare in childhood. Its renal manifestations similarity with IgA vasculitis can be misleading. Case presentation Herein, we report a 12-years-old girl with the clinical picture of IgA vasculitis and renal involvement at the time of presentation, over time, elevated cytoplasmic Anti-neutrophil Cytoplasmic Antibody (C-ANCA) and tissue biopsy confirmed GPA. Conclusion In the case of a patient with an unusual presentation of IgA vasculitis, to some degree of suspicion, the GPA should be considered. Also, in approach to non-thrombocytopenic palpable petechia and purpura a wide range of differential diagnosis such as infections, ANCA associated vasculitis, and secondary vasculitis should be considered. Therefore, 2 effective method of GPA diagnosis, the high titer of C-ANCA test and tissue biopsy, should be considered simultaneously.
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Affiliation(s)
- Vadood Javadi Parvaneh
- Department of Pediatric Rheumatology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arezoo Shirzani
- Resident of Pediatrics, Department of Pediatrics, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khosro Rahmani
- Department of Pediatric Rheumatology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Shiari
- Department of Pediatric Rheumatology, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Rasmussen C, Tisseyre M, Garon-Czmil J, Atzenhoffer M, Guillevin L, Salem JE, Treluyer JM, Terrier B, Chouchana L. Drug-induced IgA vasculitis in children and adults: Revisiting drug causality using a dual pharmacovigilance-based approach. Autoimmun Rev 2020; 20:102707. [PMID: 33197572 DOI: 10.1016/j.autrev.2020.102707] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 08/06/2020] [Accepted: 08/14/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES IgA vasculitis (IgAV) is an immune complex small-vessel vasculitis. Drug-induced IgAV cases were rarely reported in the literature. Drug causality assessment is challenging as many other etiological factors can be involved. We performed a pharmacovigilance study to identify the main drugs reported to induce IgAV. METHODS We used the French pharmacovigilance database (FPVD) and the WHO global individual case safety reports database (VigiBase) to retrieve IgAV cases. Cases from the FPVD were reviewed by two investigators using predefined criteria. Disproportionality analyses (case - non-case approach) were conducted in VigiBase to identify drugs significantly associated with IgAV reporting. RESULTS Of the 467 IgAV cases retrieved from the FPVD, 115 (47 children and 68 adults) have been assessed as definite or probable, reported with 178 suspected drugs. Overall IgAV cases were mainly male (58%), with a median age of 33.5 (8.0-63.3) years. No death was reported. Besides, we identified 1558 possible IgAV cases in VigiBase. Among them, 40 were associated with a disproportionality in IgAV reporting. Drugs were mainly vaccines, antibiotics and TNF-α blockers, these finding being consistent in both databases. IgAV reporting with TNF-α blockers was significantly associated with their use in inflammatory bowel diseases, psoriasis or ankylosing spondylitis compared to other indications. CONCLUSIONS Our systematic study enables the identification of culprit drugs in drug-induced IgAV. These results strengthen the immune pathophysiology of IgAV and the role of underlying disease. The list of suspected drugs may be useful for physicians to manage patients with IgAV and consider appropriate drug discontinuation. KEY MESSAGES What is already known about this subject? IgA vasculitis has multifactorial etiology. To date, possible culprit drugs have been reported only in case reports. What does this study add? Using a dual pharmacovigilance-based approach, we identified drugs associated with the occurrence of IgA vasculitis, such as all types of vaccines, major antibiotics and immunomodulatory agents, mainly TNF-α blockers. How might this impact on clinical practice or future developments? Physicians should be aware of drug-induced IgA vasculitis and we provide evidence on the most frequent implicated drugs.
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Affiliation(s)
- Camille Rasmussen
- National Referral Centre for Systemic and Autoimmune Diseases, Department of Internal Medicine, Cochin Hospital, AP-HP Centre - Université de Paris, Paris, France
| | - Mylène Tisseyre
- Regional Center of Pharmacovigilance, Department of Pharmacology, Cochin Hospital, AP-HP Centre - Université de Paris, Paris, France
| | - Julie Garon-Czmil
- Department of Clinical Pharmacology and Pharmacovigilance, University Hospital of Nancy Brabois, Vandoeuvre Lès Nancy, France
| | - Marina Atzenhoffer
- Department of Clinical Pharmacology and Pharmacovigilance, Hospices civils de Lyon, 69424 Lyon, France
| | - Loic Guillevin
- National Referral Centre for Systemic and Autoimmune Diseases, Department of Internal Medicine, Cochin Hospital, AP-HP Centre - Université de Paris, Paris, France
| | - Joe-Elie Salem
- Department of Pharmacology, Pitié-Salpêtrière Hospital, AP-HP Sorbonne Université, Paris, France
| | - Jean-Marc Treluyer
- Regional Center of Pharmacovigilance, Department of Pharmacology, Cochin Hospital, AP-HP Centre - Université de Paris, Paris, France
| | - Benjamin Terrier
- National Referral Centre for Systemic and Autoimmune Diseases, Department of Internal Medicine, Cochin Hospital, AP-HP Centre - Université de Paris, Paris, France
| | - Laurent Chouchana
- Regional Center of Pharmacovigilance, Department of Pharmacology, Cochin Hospital, AP-HP Centre - Université de Paris, Paris, France.
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23
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Xu X, Li X, Pradhan S, Li W. Acne fulminans concomitant with vasculitis-like symptoms mimicking Henoch-Schoenlein purpura. Pediatr Dermatol 2020; 37:1169-1170. [PMID: 33006150 DOI: 10.1111/pde.14373] [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] [Indexed: 02/05/2023]
Abstract
Acne fulminans is a severe form of acne vulgaris accompanied by systemic symptoms. A 17-year-old Chinese boy presented with an outbreak of necrotic lesions on his face eight days after the onset of palpable purpura, arthralgia, fever, abdominal pain, and proteinuria. He was successfully treated with oral prednisolone and isotretinoin. Vasculitis-like symptoms are rarely reported in acne fulminans; therefore, the physician needs to maintain awareness of this uncommon presentation.
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Affiliation(s)
- Xiaoxi Xu
- Department of Dermatovenereology, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaohua Li
- Department of Dermatovenereology, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Sushmita Pradhan
- Department of Dermatovenereology, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Li
- Department of Dermatovenereology, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
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Mohamoud M, Horgan C, Eworuke E, Dee E, Bohn J, Shapira O, Munoz MA, Stojanovic D, Sansing-Foster V, Ajao A, La Grenade L. Complementary Use of U.S. FDA's Adverse Event Reporting System and Sentinel System to Characterize Direct Oral Anticoagulants-Associated Cutaneous Small Vessel Vasculitis. Pharmacotherapy 2020; 40:1099-1107. [PMID: 33090530 DOI: 10.1002/phar.2468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cutaneous small vessel vasculitis (CSVV) has been reported after exposure to direct oral anticoagulants (DOACs), such as dabigatran, rivaroxaban, apixaban, and edoxaban. OBJECTIVE We used the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) to describe clinical characteristics associated with CSVV among DOAC-exposed patients. Furthermore, we characterized this signal in the Sentinel System to relate the clinical data from the individual FAERS cases to population-based electronic healthcare data. METHODS We queried FAERS for all cases of CSVV associated with DOACs from U.S. approval date of each DOAC through March 16, 2018. Within the Sentinel System, we identified incident CSVV cases using ICD-9 and ICD-10 diagnosis codes among adults aged ≥ 30 years who received a DOAC in the prior 90 days between January 1, 2010, and June 30, 2018. We excluded patients with evidence of select autoimmune diagnoses in the 183 days prior to their CSVV diagnoses and reported patient characteristics in the 183-day period prior to CSVV diagnoses. RESULTS In FAERS, we identified 50 cases of CSVV reported with rivaroxaban (n=26), apixaban (n=14), dabigatran (n=9), and edoxaban (n=1). Approximately 50% of the cases reported time to onset within 10 days after DOAC exposure. When specified, the predominant type of CSVV reported was leukocytoclastic vasculitis (n=31), followed by Henoch-Schonlein purpura (n=4). Hospitalization occurred in most of the cases (n=37). Switching of the offending agent after the development of CSVV was reported (n=26). Three rivaroxaban (n=3) cases and one dabigatran case (n=1) reported positive rechallenge. In the Sentinel system, we identified 3659 CSVV cases with prior DOAC exposure, with 85% of events occurring within 10 days. CONCLUSIONS The assessment of FAERS cases, combined with the temporal clustering of the Sentinel System cases suggest a possible causal relationship of DOACs and CSVV. Future efforts should characterize the risk of CSVV among the various DOAC users.
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Affiliation(s)
- Mohamed Mohamoud
- Division of Pharmacovigilance, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Casie Horgan
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Efe Eworuke
- Division of Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Elizabeth Dee
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Justin Bohn
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Oren Shapira
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Monica A Munoz
- Division of Pharmacovigilance, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Danijela Stojanovic
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Veronica Sansing-Foster
- Division of Epidemiology, Office of Clinical Evaluation and Analysis, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Adebola Ajao
- Division of Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Lois La Grenade
- Division of Pharmacovigilance, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
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Chai W, Wang X, Wang W, Wang H, Mou W, Gui J. Decreased glycolysis induced dysfunction of NK cells in Henoch-Schonlein purpura patients. BMC Immunol 2020; 21:53. [PMID: 33036556 PMCID: PMC7547466 DOI: 10.1186/s12865-020-00382-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/23/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Henoch-Schonlein purpura (HSP) is the most common systemic vasculitis of the childhood. However, its mechanisms and pathogenesis still need more exploration. Natural killer (NK) cells are innate lymphocytes, and there is a growing appreciation that cellular metabolism is important in determining the immune responsiveness of lymphocytes. Thus, we aimed to analyze the NK cells phenotype and explore the association between glucose metabolism and NK cells function in HSP patients. RESULTS A total number of 64 HSP patients and 34 healthy children were included. The HSP patients were divided into two groups according to whether accompanied with nephritis or not. NK cells in HSP patients without nephritis showed a reduced frequency in peripheral blood, a down-regulated expression of activating receptors both NKp30 and NKp46, and an attenuated cytotoxic function against tumor cells. In addition, the function impairment of NK cells was shown to exacerbate in HSPN. Our data further revealed an aberrant metabolic reprogramming of NK cells in HSP patients. Upon stimulation with cytokines (IL-15, IL-12 and IL-2), NK cells from healthy controls switched to an elevated glycolysis rate to support their effector function. By contrast, the glycolysis rate of activated NK cells in HSP group was not significantly up-regulated from the resting level possibly owing to the inhibition of mTORC1. CONCLUSIONS Our study found that HSP patients were accompanied with dysfunction of NK cells. We concluded that the dysfunction of NK cells in HSP patients was induced with a decreased glycolysis rate and suggested that metabolic reprogramming of NK cells might be a player in the pathogenesis of HSP.
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Affiliation(s)
- Wenjia Chai
- Laboratory of Tumor Immunology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Xiaolin Wang
- Laboratory of Tumor Immunology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Wei Wang
- Laboratory of Tumor Immunology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Hui Wang
- Laboratory of Tumor Immunology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Wenjun Mou
- Laboratory of Tumor Immunology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Jingang Gui
- Laboratory of Tumor Immunology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
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You SJ, Sun YX, Guo FY, Chen F, He Q, Li YN, He SY, Wang XT, Liu C. [Clinical efficacy and safety of acupuncture combined with western medicine in treatment of children with abdominal Henoch-Schonlein purpura with spleen-stomach damp-heat syndrome]. Zhen Ci Yan Jiu 2020; 45:671-675. [PMID: 32869580 DOI: 10.13702/j.1000-0607.190649] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To investigate the clinical effect of acupuncture combined with western medicine in the treatment of children with abdominal Henoch-Schonlein purpura with spleen-stomach damp-heat syndrome. METHODS A total of 60 children with abdominal Henoch-Schonlein purpura with spleen-stomach damp-heat syndrome were randomly divided into treatment group and control group, with 30 patients in each group. The patients in the control group were given Hydroprednisone 2 mg•kg-1•d-1, and in addition to the treatment in the control group, those in the treatment group were given acupuncture at Tianshu (ST25), Neiguan (PC6), Zusanli (ST36), Zhongwan (CV12), Qihai (CV6), and Sanyinjiao (SP6) once a day, with a needle retaining time of 15 minutes. Both groups were treated for 7 days. The scores of abdominal pain, hematochezia, hematemesis, vomiting, poor appetite, abdominal distension, purpura, occult blood in stool, and abdominal ultrasound were determined before and after treatment, and the time to the disappearance of abdominal pain was observed. Clinical outcome was evaluated. RESULTS The treatment group had a significantly higher effective rate than the control group [96.7% (29/30) vs 80.0% (24/30), P<0.05]. Both groups had significant reductions in the scores of abdominal pain, hematochezia, hematemesis, poor appetite, abdominal distension, purpura, occult blood and abdominal ultrasound and the total score after treatment (P<0.05), and compared with the control group after treatment, the treatment group had significantly lower scores of abdominal pain, poor appetite, abdominal distension, and abdominal ultrasound and total score (P<0.05). The treatment group had a significantly shorter time to disappea-rance of abdominal pain than the control group (P<0.05). CONCLUSION Acupuncture combined with western medicine has a better clinical effect than western medicine alone in the treatment of abdominal Henoch-Schonlein purpura with spleen-stomach damp-heat syndrome and can significantly improve clinical symptoms and signs and shorten the time to disappearance of abdominal pain.
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Affiliation(s)
- Sheng-Jie You
- Department of Traditional Chinese Medicine, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Ying-Xue Sun
- Department of Traditional Chinese Medicine, Tangshan Maternal and Child Health Hospital, Tangshan 063000, Hebei Province
| | - Fei-Yu Guo
- Center for Preventive Treatment, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 101000
| | - Fang Chen
- Department of Traditional Chinese Medicine, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Qiang He
- Department of Traditional Chinese Medicine, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Ya-Nan Li
- Department of Traditional Chinese Medicine, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Song-Yu He
- Department of Traditional Chinese Medicine, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Xin-Tai Wang
- Department of Traditional Chinese Medicine, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Chang Liu
- Department of Traditional Chinese Medicine, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
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Mohamed M, Shariff M, Al Hillan A, Haj RA, Kaunzinger C, Hossain M, Asif A, Pyrsopoulos NT. A Rare Case of Helicobacter pylori Infection Complicated by Henoch-Schonlein Purpura in an Adult Patient. J Med Cases 2020; 11:160-165. [PMID: 34434390 PMCID: PMC8383653 DOI: 10.14740/jmc3480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/07/2020] [Indexed: 01/08/2023] Open
Abstract
Henoch-Schonlein purpura (HSP) is known as a leukocytoclastic vasculitis of small vessels, resulting in skin, joint, gastrointestinal (GI) and renal involvement. It is the most common acute vasculitis in children but is relatively uncommon in adults. The pathogenesis of HSP remains unclear, but a wide variety of conditions such as bacterial or viral infections, vaccinations, drugs and other environmental exposures may be responsible for the onset. A few previous case reports have described an association between gastric Helicobacter pylori (HP) infection and HSP. A 30-year-old Indian man who migrated to the USA from India 3 years prior to this presentation with a past medical history of psoriasis on remission, not on any medications presented to the emergency department with sudden onset constant abdominal pain for 5 days. The pain was in the right upper quadrant, spasmodic in nature. The abdominal examination was normal. The patient was evaluated with complete blood count, comprehensive metabolic panel, urinalysis, computed tomography scan of abdomen and pelvis, and right upper quadrant ultrasound, all of which were negative except for leukocytosis. He was discharged on pantoprazole and tramadol. Pain continued despite treatment. Patient was readmitted 2 days later, when he noticed a new maculopapular rash on both legs. Upper GI endoscopy was done showing non-bleeding small gastric ulcer with multiple duodenal erosions. Gastric biopsy came back positive for HP and he was started on clarithromycin, amoxicillin and lansoprazole. Pain persisted after finishing antibiotic course. Rash continued to spread to involve the thighs, flanks, around the umbilicus and extensor surfaces of arms. Immunological workup was negative. A skin biopsy of the skin rash came back positive for leukocytoclastic vasculitis. HSP diagnosis was made by exclusion. Patient was started on prednisone 40 mg daily and improved drastically on the following day. He was continued steroids taper for 8 weeks. Rash as well as abdominal pain resolved completely. In conclusion, HSP involves the skin, GI tract, joints and kidneys. It is a pediatric disease and rarely occurs in adults. It can be associated with underlying malignancy in adults. HP infection can trigger HSP in pediatric and adult patients. Detection of the carrier state is crucial in HSP patients in areas where HP is endemic. Eradication of HP infection is usually associated with the resolution of HSP. In resistant cases with GI and renal involvement, corticosteroids use results in resolution of symptoms and reduction of the duration of mild nephritis.
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Affiliation(s)
- Mujtaba Mohamed
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Mohammed Shariff
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Alsadiq Al Hillan
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Rani Al Haj
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Christian Kaunzinger
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Mohammad Hossain
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Arif Asif
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Nikolaos T Pyrsopoulos
- Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers New Jersey Medical School, 185 South Orange Avenue, H-532, Newark, NJ 07103, USA
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Lee KH, Hong SH, Jun J, Jo Y, Jo W, Choi D, Joo J, Jung G, Ahn S, Kronbichler A, Eisenhut M, Shin JI. Treatment of refractory IgA vasculitis with dapsone: a systematic review. Clin Exp Pediatr 2020; 63:158-163. [PMID: 32024340 PMCID: PMC7254170 DOI: 10.3345/kjp.2019.00514] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/23/2019] [Indexed: 11/27/2022] Open
Abstract
IgA vasculitis, formerly known as Henoch-Schönlein purpura, is a systemic IgA-mediated vasculitis of the small vessels commonly seen in children. The natural history of IgA vasculitis is generally self-limiting; however, one-third of patients experience symptom recurrence and a refractory course. This systematic review examined the use of dapsone in refractory IgA vasculitis cases. A literature search of PubMed databases retrieved 13 articles published until June 14, 2018. The most common clinical feature was a palpable rash (100% of patients), followed by joint pain (69.2%). Treatment response within 1-2 days was observed in 6 of 26 patients (23.1%) versus within 3-7 days in 17 patients (65.4%). Relapse after treatment discontinuation was reported in 17 patients (65.4%) but not in 3 patients (11.5 %). Four of the 26 patients (15.4%) reported adverse effects of dapsone including arthralgia (7.7%), rash (7.7%), and dapsone hypersensitivity syndrome (3.8%). Our findings suggest that dapsone may affect refractory IgA vasculitis. Multicenter randomized placebo-controlled trials are necessary to determine the standard dosage of dapsone at initial or tapering of treatment in IgA vasculitis patients and evaluate whether dapsone has a significant benefit versus steroids or other medications.
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Affiliation(s)
- Keum Hwa Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.,Division of Pediatric Nephrology, Severance Children's Hospital, Seoul, Korea
| | | | - Jinhae Jun
- Yonsei University College of Medicine, Seoul, Korea
| | - Youngheun Jo
- Yonsei University College of Medicine, Seoul, Korea
| | - Woogyeong Jo
- Yonsei University College of Medicine, Seoul, Korea
| | - Dayeon Choi
- Yonsei University College of Medicine, Seoul, Korea
| | - Jeongho Joo
- Yonsei University College of Medicine, Seoul, Korea
| | - Guhyun Jung
- Yonsei University College of Medicine, Seoul, Korea
| | - Sunghee Ahn
- Yonsei University College of Medicine, Seoul, Korea
| | - Andreas Kronbichler
- Department of Internal Medicine IV (Nephrology and Hypertension), Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Eisenhut
- Luton & Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.,Division of Pediatric Nephrology, Severance Children's Hospital, Seoul, Korea.,Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea
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Winkler CT, Dobson RW, Tranovich MJ. Low Back Pain and Swelling as an Atypical Presentation of IgA Vasculitis. Clin Pract Cases Emerg Med 2020; 4:241-243. [PMID: 32426683 PMCID: PMC7219997 DOI: 10.5811/cpcem.2019.11.44574] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/06/2019] [Accepted: 11/26/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction Immunoglobulin A vasculitis (IgA vasculitis), formerly Henoch-Schonlein purpura, is the most common vasculitis in children. Case Report A 6-year-old female presented with low back pain and swelling, difficulty ambulating, and rash two weeks after a respiratory infection. She was approached with a broad differential and ultimately diagnosed with IgA vasculitis. Discussion Cutaneous manifestations, arthralgias, renal and gastrointestinal involvement are the most common presenting signs of IgA vasculitis. Only two cases of IgA vasculitis associated with lumbar pain and swelling were identified in the literature. Conclusion While rash and joint pain are common presenting signs of IgA vasculitis, practitioners should be aware it can present atypically.
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Affiliation(s)
- Clay T Winkler
- Prisma Health - University of South Carolina School of Medicine, Department of Emergency Medicine, Columbia, South Carolina
| | - Raymond W Dobson
- West Virginia School of Osteopathic Medicine, Lewisburg, West Virginia
| | - Michael J Tranovich
- Ohio Valley Medical Center, Department of Emergency Medicine, Wheeling, West Virginia
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Koracevic G, Marjanovic G, Jovanovic D, Djordjevic M, Kostic T, Lovic D. Rare combination of infective endocarditis in a drug abuser with Henoch-Schoenlein purpura. J BIOL REG HOMEOS AG 2020; 34:05. [PMID: 32107891 DOI: 10.23812/19-301-l] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- G Koracevic
- Department for Cardiovascular Diseases, Clinical Center Nis and Medical Faculty, University of Nis, Serbia
| | - G Marjanovic
- Department of Haematology and Clinical Immunology, Clinical Center Nis and Medical Faculty, University of Nis, Serbia
| | - D Jovanovic
- Department of Dermatology, Clinical Center Nis and Medical Faculty, University of Nis, Serbia
| | - M Djordjevic
- Emergency Medical Service, Health Center Jagodina, Serbia
| | - T Kostic
- Department for Cardiovascular Diseases, Clinical Center Nis and Medical Faculty, University of Nis, Serbia
| | - D Lovic
- Clinic for Internal Disease Intermedica, Nis, Serbia
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Hernández-Rodríguez J, Carbonell C, Mirón-Canelo JA, Diez-Ruiz S, Marcos M, Chamorro AJ. Rituximab treatment for IgA vasculitis: A systematic review. Autoimmun Rev 2020; 19:102490. [PMID: 32062030 DOI: 10.1016/j.autrev.2020.102490] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Immunoglobulin A vasculitis (IgAV) is a systemic small vessel vasculitis for which treatment of severe cases is usually based on glucocorticoids and other conventional immunosuppressive drugs. The role of rituximab for resistant or refractory cases has been explored in isolated case reports and small series. AIMS To perform a literature review of all pediatric and adult patients with IgAV treated with rituximab (RTX) and to assess disease characteristics, RTX efficacy and safety. METHODS We conducted a systematic literature review according to PRISMA guidelines by selecting articles with information on IgAV and RTX up to October 2019. We extracted data on patient characteristics, disease course, RTX efficacy and tolerance. The resulting database was analyzed with statistical software package SPSS v 22.0. RESULTS Among the initial 161 articles found, 20 studies including 35 well-characterized IgAV patients treated with RTX were finally analyzed. Distribution by sex was similar, and the median age at diagnosis was 26 (range: 2 months to 70 years). Patients included were equally diagnosed at pediatric age and in the adulthood. Almost 90% of patients had renal involvement before RTX treatment and resistant or refractory disease to glucocorticoids or other immunosuppressive agents, mainly with renal impairment, was the reason for RTX administration in 85.7% of patients. RTX was used because of contraindication to these previous agents in 8.6% of patients, and as first line therapy in 5.7% of them. With regard to RTX response, 94.3% of patients presented clinical improvement of any type and 74.3% achieved sustained remission at the end of follow-up. Among the 13 (37.1%) patients who experienced a disease relapse, 11 (31.4%) were treated with a new RTX dose, with good disease control in all cases. In terms of treatment requirements, glucocorticoids and additional immunosuppressants were significantly lower after RTX administration. No deaths were observed and the rate of minor RTX-associated adverse effects was of 8.6%. CONCLUSION RTX seems to be a safe and useful agent in inducing disease remission and reducing previous immunosuppressive treatment in IgAV pediatric and adult patients resistant or refractory to glucocorticoids or other immunosuppressive drugs, and in those patients in whom these agents are contraindicated. Nevertheless, controlled clinical trials in are still warranted to clarify the role of RTX in IgAV.
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Affiliation(s)
- José Hernández-Rodríguez
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clínic of Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Cristina Carbonell
- Conective Tissue Diseases Unit, Department of Internal Medicine, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | - José-A Mirón-Canelo
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Salamanca, Salamanca, Spain; Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Sandra Diez-Ruiz
- Department of Medicine, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - Miguel Marcos
- Conective Tissue Diseases Unit, Department of Internal Medicine, Hospital Clínico Universitario de Salamanca, Salamanca, Spain; Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain; Department of Medicine, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - Antonio J Chamorro
- Conective Tissue Diseases Unit, Department of Internal Medicine, Hospital Clínico Universitario de Salamanca, Salamanca, Spain; Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain; Department of Medicine, Faculty of Medicine, University of Salamanca, Salamanca, Spain.
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Liu Q, Yang Y, Ge S, Huo J, Wang D, Ma Y, Shi S, Luo D, Deng J, Ren C, Guo B. Serum level of advanced oxidation protein products (AOPPs) in patients with Henoch-Schonlein purpura and its relationship with aberrant glycosylation of IgA1 and Cosmc mRNA expression. Int J Dermatol 2019; 58:1092-1097. [PMID: 31250447 PMCID: PMC6852516 DOI: 10.1111/ijd.14550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 02/28/2019] [Accepted: 05/20/2019] [Indexed: 11/28/2022]
Abstract
Background Henoch–Schonlein purpura (HSP) is a systemic small vessel vasculitis that is mainly caused by IgA1‐type immune complex deposition. Advanced oxidation protein products (AOPPs) are specific markers of protein oxidation. Objective To explore the role of AOPPs in the pathogenesis of HSP. Methods There are 51 HSP patients who were divided into four subgroups: (i) skin type – 20 cases; (ii) joint type – 8 cases; (iii) abdominal type – 12 cases; (iv) renal type – 11 cases; and 18 healthy volunteers were enrolled as controls. The serum levels of AOPPs and Gd‐IgA1 were quantified by an HAA‐lectin‐based ELISA. The Cosmc mRNA expression in peripheral B lymphocytes was measured by RT‐PCR. Results 1. Advanced oxidation protein products in different subgroups of HSP patients are all higher than the controls, while the renal‐type subgroup is the highest and the skin‐type subgroup is the lowest. 2. Spearman correlation analysis shows that: (i) AOPPs and Gd‐IgA1 in HSP patients are positively correlated; both of them are positively correlated with the disease severity scores; (ii) AOPPs are negatively correlated with the relative expression value (RQ) of Cosmc mRNA. Conclusion Advanced oxidation protein products play an important role in the pathogenesis of HSP, especially in renal‐type patients.
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Affiliation(s)
- Qiang Liu
- Dermatovenerological Department, The Second Hospital of HeBei Medical University, Shijiazhuang, HeBei Province, China
| | - Yun Yang
- Dermatovenerological Department, The Second Hospital of HeBei Medical University, Shijiazhuang, HeBei Province, China
| | - Shealinna Ge
- Dermatovenerological Department, University of Maryland School of Medicine,, Baltimore, MD, USA
| | - JianLi Huo
- Dermatovenerological Department, Central Hospital, Zhuozhou, HeBei Province, China
| | - DaHu Wang
- Dermatovenerological Department, The Second Hospital of HeBei Medical University, Shijiazhuang, HeBei Province, China
| | - YaoHui Ma
- Dermatovenerological Department, The Second Hospital of HeBei Medical University, Shijiazhuang, HeBei Province, China
| | - ShaoMin Shi
- Dermatovenerological Department, Shijiazhuang Fifth Hospital, Shijiazhuang, HeBei Province, China
| | - Ding Luo
- Dermatovenerological Department, Affiliated Hospital of Hebei University, Baoding, HeBei Province, China
| | - JieHua Deng
- Dermatovenerological Department, The Second Hospital of HeBei Medical University, Shijiazhuang, HeBei Province, China
| | - CuiMin Ren
- Dermatovenerological Department, The Second Hospital of HeBei Medical University, Shijiazhuang, HeBei Province, China
| | - BingShen Guo
- Dermatovenerological Department, The Second Hospital of HeBei Medical University, Shijiazhuang, HeBei Province, China
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Mauro A, Mauro S, Rega R, Martemucci L, Sottile R. Successful treatment of hemorrhagic bullous Henoch-Schonlein purpura with intravenous immunoglobulins. Pediatr Dermatol 2019; 36:e34-e36. [PMID: 30561101 DOI: 10.1111/pde.13715] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Indexed: 01/20/2023]
Abstract
Henoch-Schonlein purpura (HSP) is the most common systemic vasculitis in childhood. There is no consensus about the management for isolated cutaneous manifestations in HSP. We describe a case of HSP presenting with severe skin lesions that did not respond to standard therapy with corticosteroids. The 11-year-old child was treated with intravenous immunoglobulins, which induced rapid and persistent resolution of symptomatology.
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Affiliation(s)
- Angela Mauro
- Department of Paediatrics, Santa Maria della Pietà Hospital, Nola-Naples, Italy
| | - Salvatore Mauro
- Department of Paediatrics, Santa Maria della Pietà Hospital, Nola-Naples, Italy
| | - Roberto Rega
- Department of Paediatrics, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Luigi Martemucci
- Department of Paediatrics, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Rita Sottile
- Department of Paediatrics, Santobono-Pausilipon Children's Hospital, Naples, Italy
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34
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Torosoff M, Breen T, Balulad S, Padala S, Lyubarova R, Tan H, Sidhu M. Resolution of sinus bradycardia, high-grade heart block, and left ventricular systolic dysfunction with rituximab therapy in Henoch-Schonlein purpura. Intern Med J 2018; 48:868-871. [PMID: 29984516 DOI: 10.1111/imj.13948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 09/13/2017] [Revised: 10/26/2017] [Accepted: 10/28/2017] [Indexed: 01/23/2023]
Abstract
Henoch-Schonlein purpura (HSP) is a rare, typically self-limited, multi-organ vasculitis. Cardiac involvement with HSP carries high morbidity and mortality, thus requiring early aggressive immunosuppressive therapy. We report a case of HSP complicated with acute systolic left ventricular (LV) dysfunction, symptomatic sinus bradycardia and high-grade atrio-ventricular (AV) heart block. Cyclophosphamide, a commonly used agent in HSP, was contraindicated due to the patient's presentation with acute renal failure. Treatment with monoclonal antibody rituximab and corticosteroids was initiated with an improvement in and resolution of LV systolic dysfunction, sinus bradycardia and AV block. We believe this is the first published report on rituximab treatment in HSP with cardiac involvement manifesting with severe LV systolic dysfunction, sinus bradycardia and high-grade AV block.
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Affiliation(s)
| | | | | | - Santosh Padala
- Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | | | - Henry Tan
- Albany Medical Center, Albany, New York, USA
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Yu SF, Feng WY, Chai SQ, Meng XB, Dou ZX, Zhu H. Down-Regulation of miR-218-5p Promotes Apoptosis of Human Umbilical Vein Endothelial Cells Through Regulating High-Mobility Group Box-1 in Henoch-Schonlein Purpura. Am J Med Sci 2018; 356:64-71. [PMID: 29751935 DOI: 10.1016/j.amjms.2018.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 09/19/2017] [Revised: 04/02/2018] [Accepted: 04/04/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Apoptosis of human umbilical vein endothelial cells (HUVECs) plays an important role in the progression of Henoch-Schonlein purpura (HSP). In the present study, we explored the function of miR-218-5p in HUVEC apoptosis and HSP development. MATERIALS AND METHODS HSP rat model was established and peripheral blood mononuclear cells (PBMC) were isolated. The expression of miR-218-5p and high-mobility group box-1 (HMGB1) protein in HUVECs was determined by quantitative real-time polymerase chain reaction and western blot, respectively. Cell apoptosis was detected by terminal deoxynucleotidyl transferase dUTP nick end labeling assay. The association between miR-218-5p and HMGB1 was determined by luciferase assay. The endogenous expression of related genes was modulated with recombinant plasmids and cell transfection. RESULTS MiR-218-5p was down-regulated and HMGB1 was up-regulated in vessels of the lower limb of HSP rats and in HUVECs co-cultured in HSP PBMC supernatant. MiR-218-5p negatively regulated HMGB1 by targeting its 3'-untranslated regions. Over expression of miR-218-5p reversed the increased apoptosis and HMGB1 expression observed in HUVECs co-cultured in PBMC supernatant, whereas miR-218-5p knockdown showed the opposite outcomes. Furthermore, the miR-218-5p mimic demonstrated an inhibitory effect on the apoptosis of HUVECs co-cultured in PBMC supernatant, which was reversed by over expression of HMGB1. In HSP rats, over expression of miR-218-5p attenuated HSP and decreased the level of HMGB1. CONCLUSIONS MiR-218-5p attenuated HSP at least partly through regulating HMGB1 expression and affecting the function of HUVECs.
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Affiliation(s)
- Shao-Fei Yu
- Department of Pediatrics, Inner Mongolia People's Hospital, Huhhot, Inner Mongolia, China.
| | - Wan-Yu Feng
- Department of Pediatrics, Inner Mongolia People's Hospital, Huhhot, Inner Mongolia, China
| | - Shao-Qing Chai
- Department of Pediatrics, Inner Mongolia People's Hospital, Huhhot, Inner Mongolia, China
| | - Xiao-Bo Meng
- Department of Pediatrics, Inner Mongolia People's Hospital, Huhhot, Inner Mongolia, China
| | - Zhong-Xia Dou
- Department of Pediatrics, Inner Mongolia People's Hospital, Huhhot, Inner Mongolia, China
| | - Hua Zhu
- Department of Pediatrics, Inner Mongolia People's Hospital, Huhhot, Inner Mongolia, China
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Yuan L, Wang Q, Zhang S, Zhang L. Correlation between serum inflammatory factors TNF-α, IL-8, IL-10 and Henoch-Schonlein purpura with renal function impairment. Exp Ther Med 2018; 15:3924-3928. [PMID: 29556266 PMCID: PMC5844035 DOI: 10.3892/etm.2018.5876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 01/12/2018] [Indexed: 01/20/2023] Open
Abstract
The changes of tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8), interleukin-10 (IL-10) in the serum of Henoch-Schonlein purpura nephritis (HSPN) patients were analyzed to explore the correlation between the above inflammatory factors and progression of the disease. The present study used the double antibody sandwich enzyme-linked immunosorbent assay (ELISA) method to detect the serum levels of TNF-α, IL-8, IL-10 and urine protein in 112 cases of patients with Henoch-Schonlein purpura (HSP), including 54 cases of HSP combined with renal function impairment (group HSPN), and 58 cases not combined with renal function impairment (NHSPN), as well as 50 healthy patients who were selected as the control group. The concentration of TNF-α, IL-8, and IL-10 in the serum of HSP patients were higher than that of the control group, and the difference was statistically significant (P<0.05). There was no significant difference in the levels of IL-10, and IL-8 between the HSPN group and the NHSPN group (P>0.05), but the level of TNF-α in the serum of HSPN group was significantly higher than that of NHSPN group (P<0.05). TNF-α, IL-8 and IL-10 levels of the acute nephritis, chronic nephritis and nephrotic syndrome groups were all higher than the simple proteinuria group. In addition, the levels of the three factors of the acute nephritis group were all higher than those of the chronic nephritis and nephrotic syndrome groups (P<0.05). IL-8, IL-10, and TNF-α were positively correlated with the urinary protein levels. The results indicated that the levels of serum TNF-α, IL-8 and IL-10 are correlated with HSPN, and serum TNF-α concentration can be used as an indicator of the severity of HSPN.
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Affiliation(s)
- Liangdong Yuan
- Department of Nephrology, The Affiliated Hospital of Jining Medical University, Jining, Shandong 272400, P.R. China
| | - Quanyi Wang
- Department of Pathology, The Affiliated Hospital of Jining Medical University, Jining, Shandong 272400, P.R. China
| | - Shiqi Zhang
- Department of Nephrology, The Affiliated Hospital of Jining Medical University, Jining, Shandong 272400, P.R. China
| | - Ling Zhang
- The First Maternity and Child Health Care Hospital of Rencheng District, Jining, Shandong 272400, P.R. China
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Purevdorj N, Mu Y, Gu Y, Zheng F, Wang R, Yu J, Sun X. Clinical significance of the serum biomarker index detection in children with Henoch-Schonlein purpura. Clin Biochem 2017; 52:167-170. [PMID: 29129626 DOI: 10.1016/j.clinbiochem.2017.11.006] [Citation(s) in RCA: 18] [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: 09/06/2017] [Revised: 11/04/2017] [Accepted: 11/08/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To explore a panel of serum biomarkers for laboratory diagnosis of pediatric Henoch-Schönlein purpura (HSP). METHODS The blood white blood cells (WBC) and serum levels of serum amyloid A (SAA), interleukin 6 (IL-6), immunoglobulin A (IgA), immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin E (IgE), C-reactive protein (CRP), complement component 3 (C3), complement component 4 (C4), and ASO (anti-streptolysin O) were detected in 127 patients with Henoch-Schonlein purpura (HSP), 110 cases of septicemia patients, and 121 healthy volunteers. The diagnostic ability of biomarkers selected from HSP and septicemia patients was analyzed by ROC curve. By designing the calculation model, the biomarker index was calculated for laboratory diagnosis of HSP and differential diagnosis between HSP and septicemia. RESULTS The levels of serum WBC, CRP, IL-6 and SAA in the septicemia patients were significantly higher than those in the control group (p<0.05). Compared with the healthy individuals, serum levels of WBC, CRP, IL-6, SAA, IgA and IgM were significantly increased in patients with HSP (p<0.05). The area under the curve (AUC) of SAA, IgA, IgM, WBC, IL-6, and CRP in the patients with HSP was 0.964, 0.855, 0.849, 0.787, 0.765, and 0.622, respectively. The values of SAA, IgA, IgM, WBC, IL-6, and CRP in septicemia patients were 0.700, 0.428, 0.689, 0.682, 0.891, and 0.853, respectively. Biomarker index=SAA+IgA/4000+IgM/4000×0.4CRPmean valueCRPi. The biomarker index in HSP patients was significantly higher than that of the healthy controls. However, the biomarker index in septicemia patients was significantly lower than the control. CONCLUSION The biomarker index of HSP patients is higher than that of the control group. While in the infectious disease represented by septicemia, it is decreased. The detection of biomarker index could exclude the interference of infection as the auxiliary examination to HSP patients.
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Affiliation(s)
- Narangerel Purevdorj
- School of Medical Laboratory, Tianjin Medical University, No.1 Guangdong Road, Hexi District, Tianjin 300203, China
| | - Yun Mu
- Department of Clinical Laboratory, Tianjin Children's Hospital, 238 Longyan Road, Beichen District, Tianjin 300134, China
| | - Yajun Gu
- School of Medical Laboratory, Tianjin Medical University, No.1 Guangdong Road, Hexi District, Tianjin 300203, China
| | - Fang Zheng
- School of Medical Laboratory, Tianjin Medical University, No.1 Guangdong Road, Hexi District, Tianjin 300203, China
| | - Ran Wang
- School of Medical Laboratory, Tianjin Medical University, No.1 Guangdong Road, Hexi District, Tianjin 300203, China
| | - Jinwei Yu
- School of Medical Laboratory, Tianjin Medical University, No.1 Guangdong Road, Hexi District, Tianjin 300203, China
| | - Xuguo Sun
- School of Medical Laboratory, Tianjin Medical University, No.1 Guangdong Road, Hexi District, Tianjin 300203, China.
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Ofori E, Ramai D, Ona MA, Papafragkakis C, Reddy M. Adult-Onset Henoch-Schonlein Purpura Duodenitis. J Clin Med Res 2017; 9:958-961. [PMID: 29038676 PMCID: PMC5633099 DOI: 10.14740/jocmr3181w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 09/15/2017] [Indexed: 11/11/2022] Open
Abstract
Henoch-Schonlein purpura (HSP) is an immune-mediated vasculitis. HSP presents with purple spots on the skin (purpura), arthralgia, digestive problems, and kidney injury. HSP is most commonly seen in children, and rarely presents in adults. The pathogenesis involves the deposition of immune complexes in small to medium size blood vessels which leads to necrosis and inflammation. Most patients recover after symptomatic treatment, while more severe cases are treated with steroids. We report a 28-year-old female patient who presented with two episodes of hematemesis, worsening abdominal pain, and bloody diarrhea. Physical examination showed erythematous, palpable, purpuric rashes on her thighs and lower legs. Contrast-enhanced computed tomography (CT) scan showed thickening of the duodenal wall, and upper endoscopy revealed mild gastric erythema and diffuse erythematous, hemorrhagic, friable mucosa with superficial, thick, adherent white exudate seen in the second portion of the duodenum, consistent with the diagnosis of HSP. We report on the clinical presentation of our patient, and review adult-onset HSP.
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Affiliation(s)
- Emmanuel Ofori
- Department of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of the Icahn School of Medicine at Mount Sinai, Clinical Affiliate of the Mount Sinai Hospital, Brooklyn, NY, USA
| | - Daryl Ramai
- Department of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of the Icahn School of Medicine at Mount Sinai, Clinical Affiliate of the Mount Sinai Hospital, Brooklyn, NY, USA.,Department of Anatomical Sciences, St George's University School of Medicine, True Blue, Grenada, WI
| | - Mel A Ona
- Division of Advanced Endoscopy, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Charilaos Papafragkakis
- MD Anderson Cancer Center, Academic and Clinical Affiliate of the University of Texas, Houston, TX, USA
| | - Madhavi Reddy
- Department of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of the Icahn School of Medicine at Mount Sinai, Clinical Affiliate of the Mount Sinai Hospital, Brooklyn, NY, USA
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Abstract
Henoch-Schönlein purpura (HSP) is systemic vasculitis disease with various clinical manifestations. Gastrointestinal symptoms in patients with HSP are usually common, with an incidence rate of 62-90%. Most of these gastrointestinal symptoms occur after typical skin purpura, which is a very important clinical evidence for making a diagnosis of HSP. It is difficult to diagnose HSP without skin rash. About 25% of patients may experience gastrointestinal symptoms as their first symptoms. Herein, we report a case of ileo-colic intussusception associated with HSP in a 5-years-old girl presented with diffuse abdominal distension. Our patient did present any symptoms of HSP, such as purpura, arthralgia or arthritis, before surgery.
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Affiliation(s)
- Keun Young Kim
- Department of Surgery, Wonkwang University School of Medicine, Iksan, Korea.,Department of Institute of Medical Science, Wonkwang University School of Medicine, Iksan, Korea
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Gur G, Cakar N, Kiremitci S, Taktak A, Basaran O, Uncu N. Preschool education impact on child development. ARCH ARGENT PEDIATR 2016. [PMID: 27606665 DOI: 10.5546/aap.2016.e366] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Henoch-Schonlein purpura (HSP) is the most common vasculitis in children. Vasculitic processes can involve the lung. Although diffuse alveolar hemorrhage may be seen as one of the manifestation of HSP, it is not a frequent presentation. Here we reported the case of a 10-year-old girl with HSP nephritis who developed pulmonary hemorrhage. The patient was treated successfully with intravenous methylprednisolone. A review of the literature revealed that young age may be a good prognostic sign and that immunosuppressive drugs and supportive management are essential in the treatment.
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Affiliation(s)
- Gokce Gur
- Department of Pediatric Nephrology, Ankara Child Health, Hematology, Oncology Education and Research Hospital, Ankara, Turkey
| | - Nilgun Cakar
- Department of Pediatric Nephrology, Ankara Child Health, Hematology, Oncology Education and Research Hospital, Ankara, Turkey.,Department of Pediatric Rheumatology, Ankara Child Health, Hematology, Oncology Education and Research Hospital, Ankara, Turkey
| | - Saba Kiremitci
- Department of Pathology, Ankara Medical School, Ankara, Turkey
| | - Aysel Taktak
- Department of Pediatric Nephrology, Ankara Child Health, Hematology, Oncology Education and Research Hospital, Ankara, Turkey
| | - Ozge Basaran
- Department of Pediatric Rheumatology, Ankara Child Health, Hematology, Oncology Education and Research Hospital, Ankara, Turkey.
| | - Nermin Uncu
- Department of Pediatric Nephrology, Ankara Child Health, Hematology, Oncology Education and Research Hospital, Ankara, Turkey.,Department of Pediatric Rheumatology, Ankara Child Health, Hematology, Oncology Education and Research Hospital, Ankara, Turkey
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Grabska-Kobylecka I, Nowak D, Wlodarczyk A, Bialasiewicz P. No impairment of pulmonary function in children with Henoch-Schonlein purpura after 4-year follow-up. Clin Rheumatol 2016; 35:2847-2850. [PMID: 27461008 DOI: 10.1007/s10067-016-3358-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 05/22/2016] [Revised: 07/13/2016] [Accepted: 07/15/2016] [Indexed: 10/21/2022]
Abstract
Henoch-Schonlein purpura (HSP) is a generalized form of IgA-mediated vasculitis that usually spares pulmonary circulation. Nevertheless, it is conceivable that subclinical changes at the HSP onset may lead to lung impairment in the long term. Therefore, we decided to follow a group of HSP patients for 4 years to monitor changes in pulmonary function. A group of 11 children and adolescents diagnosed with HSP without apparent pulmonary involvement was subjected to pulmonary function tests (PFTs), i.e., spirometry, body plethysmography, and diffusing capacity for CO (DLCO); these tests were repeated after 48 months. No significant impairment was observed in variables of spirometry, body plethysmography, and DLCO expressed as % of predicted values (% predicted) after 4 years. Specifically, no significant change in DLCO, corrected for blood hemoglobin concentration was noted, i.e., 79.3 ± 10.1 vs. 81.6 ± 14.7 % predicted at the beginning and the end of the study, respectively. IgA vasculitis seems to spare pulmonary circulation as we found no impairment in PFTs within the study time frame and a median of almost 6 years from the first episode of the disease.
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Affiliation(s)
| | - Dariusz Nowak
- Department of Clinical Physiology, Medical University of Lodz, Lodz, Poland
| | - Anna Wlodarczyk
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowiecka 6/8, 92-215, Lodz, Poland
| | - Piotr Bialasiewicz
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowiecka 6/8, 92-215, Lodz, Poland.
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Fidan K, Kandur Y, Ucar M, Gucuyener K, Soylemezoglu O. Posterior Reversible Encephalopathy Syndrome in Henoch-Schonlein Purpura and Hemolytic Uremic Syndrome. J Clin Med Res 2016; 8:544-7. [PMID: 27298664 PMCID: PMC4894025 DOI: 10.14740/jocmr2157w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2016] [Indexed: 11/24/2022] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological syndrome, composed of symptoms such as headache, seizures, visual disturbances, lethargy, confusion, stupor, focal neurologic findings and radiological findings of bilateral gray and white matter abnormalities suggestive of edema in the posterior regions of the cerebral hemispheres. PRES is associated with significant morbidity and mortality if it is not expeditiously recognized. Magnetic resonance image (MRI) represents the most sensitive imaging technique for recognizing PRES. PRES has been seen in various clinical settings including renal disorders such as acute glomerulonephritis, lupus nephritis, nephrotic syndrome, and drug usage such as calcineurin inhibitors. We aimed to present two study cases for such clinical setting. In this report, we present two patients with PRES in whom the primary diagnosis was hemolytic uremic syndrome (HUS) and Henoch-Schonlein purpura (HSP). Both of them were treated with anticonvulsant and proper antihypertensive drugs. A repeated MRI scan of the head, an ophthalmologic assessment, and a follow-up electroencephalogram produced normal results with no sequelae. Early recognition of PRES as a complication during different diseases and therapies in childhood may facilitate the appropriate treatment, so that intensive treatment should be performed as soon as possible to avoid neurological sequelae.
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Affiliation(s)
- Kibriya Fidan
- Department of Pediatric Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Yasar Kandur
- Department of Pediatric Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Murat Ucar
- Department of Radiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Kivilcim Gucuyener
- Department of Pediatric Neurology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Oguz Soylemezoglu
- Department of Pediatric Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Bomback AS, Perazella MA, Choi MJ. American Society of Nephrology Quiz and Questionnaire 2015: Glomerular Diseases. Clin J Am Soc Nephrol 2016; 11:884-890. [PMID: 26847362 PMCID: PMC4858496 DOI: 10.2215/cjn.12871215] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The Nephrology Quiz and Questionnaire remains an extremely popular session for attendees of the annual Kidney Week meeting of the American Society of Nephrology. Once again, the conference hall was overflowing with audience members and eager quiz participants. Topics covered by the expert discussants included electrolyte and acid-base disorders, glomerular disease, ESRD/dialysis, and kidney transplantation. Complex cases representing each of these categories, along with single-best-answer questions, were prepared and submitted by the panel of experts. Before the meeting, training program directors of United States nephrology fellowship programs and nephrology fellows answered the questions through an Internet-based questionnaire. During the live session, members of the audience tested their knowledge and judgment on a series of case-oriented questions prepared and discussed by the experts. They compared their answers in real time using their cell phones with a special app with the answers of the nephrology fellows and training program directors. The correct and incorrect answers were then discussed after the results of the questionnaire were displayed. As always, the audience, lecturers, and moderators enjoyed this educational session. This article recapitulates the session and reproduces its educational value for Clinical Journal of the American Society of Nephrology readers. Enjoy the clinical cases and expert discussions.
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MESH Headings
- Aged
- Educational Measurement
- Female
- Glomerulonephritis, IGA/complications
- Glomerulonephritis, IGA/diagnosis
- Glomerulonephritis, IGA/drug therapy
- Glomerulosclerosis, Focal Segmental/diagnosis
- Glomerulosclerosis, Focal Segmental/drug therapy
- Glomerulosclerosis, Focal Segmental/pathology
- Hematuria/etiology
- Humans
- Male
- Nephrology/education
- Proteinuria/etiology
- Surveys and Questionnaires
- Vasculitis, Leukocytoclastic, Cutaneous/complications
- Vasculitis, Leukocytoclastic, Cutaneous/diagnosis
- Vasculitis, Leukocytoclastic, Cutaneous/pathology
- Young Adult
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Affiliation(s)
- Andrew S. Bomback
- Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, New York
| | - Mark A. Perazella
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut; and
| | - Michael J. Choi
- Division of Nephrology, Johns Hopkins University, Baltimore, Maryland
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Modi S, Mohan M, Jennings A. Acute Scrotal Swelling in Henoch-Schonlein Purpura: Case Report and Review of the Literature. Urol Case Rep 2016; 6:9-11. [PMID: 27169017 PMCID: PMC4855902 DOI: 10.1016/j.eucr.2016.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 01/18/2016] [Accepted: 01/26/2016] [Indexed: 11/16/2022] Open
Abstract
Henoch-Schönlein purpura (HSP) is a systemic vasculitis characterized classically by purpura, arthritis and abdominal pain. Epididymitis/orchitis is rarely seen as a complication of HSP. Testicular or scrotal involvement has been reported in children with Henoch-Schonlein purpura and must be distinguished from testicular torsion. We report a case of a 5 year old boy diagnosed with Henoch-Schönlein purpura with acute scrotal swelling. He was managed successfully with conservative approach. The history, clinical examination findings and scrotal ultrasound evaluation should suffice to make the correct diagnosis and avoid surgery. Steroid treatment and/or antibiotics appeared to be effective for this condition.
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Affiliation(s)
- Sunny Modi
- Rockhampton Base Hospital, Rockhampton, Australia
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Xiong LJ, Mao M. Current views of the relationship between Helicobacter pylori and Henoch-Schonlein purpura in children. World J Clin Pediatr 2016; 5:82-88. [PMID: 26862506 PMCID: PMC4737697 DOI: 10.5409/wjcp.v5.i1.82] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/02/2015] [Accepted: 11/25/2015] [Indexed: 02/05/2023] Open
Abstract
Helicobacter pylori (H. pylori) is one of the factors involved in the pathogenesis of various gastrointestinal diseases and may play a potential role in certain extra-intestinal diseases. H. pylori infection are mainly acquired during childhood, and it has been reported that in endemic areas of China the infection rates are extraordinarily higher in HSP children, particular those with abdominal manifestations. Furthermore, eradication therapy may ameliorate Henoch-Schonlein purpura (HSP) manifestations and decrease the recurrence of HSP. Therefore, results suggested that detection of H. pylori infection by appropriate method ought to be applied in HSP children. Current evidences indicate that local injury of gastric mucosa and immunological events induced by H. pylori infection are involved in the development of HSP. Increased serum IgA, cryoglobulins, C3 levels, autoimmunity, proinflammatory substances and molecular mimicry inducing immune complex and cross-reactive antibodies caused by H. pylori infection might play their roles in the course of HSP. However, there are no investigations confirming the causality between H. pylori infection and HSP, and the pathogenesis mechanism is still unclear. More bench and clinical studies need to be executed to elaborate the complex association between H. pylori and HSP.
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Yan M, Wang Z, Niu N, Zhao J, Peng J. Relationship between chronic tonsillitis and Henoch-Schonlein purpura. Int J Clin Exp Med 2015; 8:14060-14064. [PMID: 26550368 PMCID: PMC4613053] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/12/2015] [Indexed: 06/05/2023]
Abstract
The aim of this study was to explore the relationship between children's chronic tonsillitis and Henoch-Schonlein purpura (HSP). We randomly selected 56 cases of HSP children with chronic tonsillitis during December 2009 to December 2012, 26 cases for surgery group and 30 cases for non-surgery. The duration of abdominal pain and rash, 24 hours urine protein quantity, urine red blood cell count, titre of anti streptolysin O (ASO) and complement C3 (C3) were compared and analyzed with statistical method. Compared with the non-surgery group, the duration of abdominal pain and rash, overcast days of urine protein and occult blood in the surgery group were improved significantly (P < 0.05). 24 hours urine protein quantity and urine red blood cell count of the surgery group were improved significantly after surgery (P < 0.01). Chronic tonsillitis was one of the important factors leading to recurrent rash and inducing Henoch-Schonlein purpura nephritis. Tonsillectomy was an alternative mean to treat HSP children with chronic tonsillitis.
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Affiliation(s)
- Min Yan
- Department of Paediatrics, Laiwu People's Hospital Laiwu 271100, China
| | - Zhan Wang
- Department of Paediatrics, Laiwu People's Hospital Laiwu 271100, China
| | - Na Niu
- Department of Paediatrics, Laiwu People's Hospital Laiwu 271100, China
| | - Jianxia Zhao
- Department of Paediatrics, Laiwu People's Hospital Laiwu 271100, China
| | - Jian Peng
- Department of Paediatrics, Laiwu People's Hospital Laiwu 271100, China
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Tudorache E, Azema C, Hogan J, Wannous H, Aoun B, Decramer S, Deschênes G, Ulinski T. Even mild cases of paediatric Henoch-Schönlein purpura nephritis show significant long-term proteinuria. Acta Paediatr 2015; 104:843-8. [PMID: 24946692 DOI: 10.1111/apa.12723] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 03/23/2014] [Revised: 05/15/2014] [Accepted: 06/17/2014] [Indexed: 10/25/2022]
Abstract
AIM Henoch-Schonlein purpura (HSP) is a common cause of paediatric renal disease in children, representing 10-15% of paediatric glomerulonephritis. This study examined the long-term outcome of biopsy-proven HSP nephritis to identify correlations between disease development and treatment. METHODS Patients from three French centres were retrospectively analysed. RESULTS We followed up 142 patients aged from 2 to 10.5 years with HSP nephritis, graded according to the International Study Group of Kidney Disease in Childhood classification. Mean (±SD) age at presentation was 7.6 ± 2.8 years. Nephrotic range proteinuria was present in 28% of patients with Grade II lesions, 60% with Grade III and 90% with Grade IV. Significant proteinuria (>0.5 g/L) was found in nine of 48 patients 3 years after renal biopsy, eight of 25 patients after 5 years and three of 14 patients after 10 years. There was no correlation between the proteinuria risk at 3, 5 or 10 years and the initial histological lesion or treatment modality. Treatment with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB) was linked to lower proteinuria, especially if it was started precociously. CONCLUSION Even mild forms of HSP nephritis risk significant long-term proteinuria. Very early introduction of ACEi/ARB may improve the long-term outcome independent of histological lesions.
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Affiliation(s)
- Elena Tudorache
- Department of Paediatric Nephrology; Armand-Trousseau Hospital; APHP; Paris France
- University Pierre and Marie Curie; Paris France
| | - Christine Azema
- Department of Paediatric Nephrology; Armand-Trousseau Hospital; APHP; Paris France
| | - Julien Hogan
- Department of Paediatric Nephrology; Armand-Trousseau Hospital; APHP; Paris France
| | - Hala Wannous
- Department of Paediatric Nephrology; Armand-Trousseau Hospital; APHP; Paris France
| | - Bilal Aoun
- Department of Paediatric Nephrology; Armand-Trousseau Hospital; APHP; Paris France
| | | | - Georges Deschênes
- Department of Paediatric Nephrology; Robert-Debré Hospital; APHP; Paris France
- University Paris-Diderot; Paris France
| | - Tim Ulinski
- Department of Paediatric Nephrology; Armand-Trousseau Hospital; APHP; Paris France
- University Pierre and Marie Curie; Paris France
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Abstract
Small vessel vasculitis in the skin manifests with palpable purpura on the lower extremities. This clinical presentation prompts a complete physical examination, history, and review of systems, as well as biopsies for routine processing and direct immunofluorescence to confirm the diagnosis. The presence of vasculitis in other organs, associated underlying conditions, and the severity of cutaneous manifestations dictate management. The majority of cases are self-limited, and overall the prognosis is favorable. Still, a subset of patients can have serious complications and chronic or recurrent disease.
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Affiliation(s)
- Robert G Micheletti
- Departments of Dermatology and Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - Victoria P Werth
- Departments of Dermatology and Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Departments of Dermatology and Medicine, Philadelphia Veterans Affairs Medical Center, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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49
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Dalpiaz A, Schwamb R, Miao Y, Gonka J, Walzter W, Khan SA. Urological Manifestations of Henoch-Schonlein Purpura: A Review. Curr Urol 2015; 8:66-73. [PMID: 26889120 DOI: 10.1159/000365692] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 08/16/2014] [Accepted: 09/30/2014] [Indexed: 11/19/2022] Open
Abstract
Henoch-Schonlein purpura (HSP) is an immune-mediated systemic vasculitis generally found in children. The standard manifestations of HSP are palpable purpura, arthritis, abdominal pain, and renal complications. Although less common, there are significant urological manifestations associated with HSP. The primary objective of this review is to encourage better understanding and management of HSP by emphasizing the common and rare manifestations of HSP, how they are diagnosed, and the latest treatment options for mild to severe complications. Medline searches of HSP and its urological manifestations were conducted along with searches on current diagnostic and treatment methods. Urological manifestations of HSP involve the kidney, ureter, bladder, prostate, scrotum, testicle, and penis. Diagnosis and management of HSP are not always clear due to differential diagnosis and diversity of symptom presentation. Treatment for HSP is mainly supportive and includes use of nonsteroidal anti-inflammatory drugs for pain relief. In more severe cases, glucocorticoids, methylprednisolone, plasmapheresis, and peritoneal and hemodialysis are reported successful. It is important to note different symptoms of HSP in order to distinguish HSP from other diseases. Early diagnosis may prevent severe complications. Treatment options vary from conservative to invasive depending on the severity of the disease and time frame of diagnosis.
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Affiliation(s)
- Amanda Dalpiaz
- Department of Physiology and Biophysics, Stony Brook, N.Y., USA
| | - Richard Schwamb
- Department of Physiology and Biophysics, Stony Brook, N.Y., USA
| | - Yimei Miao
- Department of Urology, SUNY School of Medicine, Stony Brook University, Stony Brook, N.Y., USA
| | - Jacquelyn Gonka
- Department of Urology, SUNY School of Medicine, Stony Brook University, Stony Brook, N.Y., USA
| | - Wayne Walzter
- Department of Urology, SUNY School of Medicine, Stony Brook University, Stony Brook, N.Y., USA
| | - Sardar A Khan
- Department of Urology, SUNY School of Medicine, Stony Brook University, Stony Brook, N.Y., USA
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Abstract
Henoch-Schonlein purpura (HSP) is an autoimmune, multisystem, acute vasculitis of childhood commonly involving the skin, gut, joints and the kidneys. Fatal complications involving various systems can occur in this disease and careful perioperative management is advocated. We report here the occurrence of postoperative bradycardia and the successful perioperative management of a 12-year-old boy with HSP for diagnostic laparoscopy.
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Affiliation(s)
- Madhuri S Kurdi
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Radhika S Deva
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - Kaushic A Theerth
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
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