Idiopathic thrombocytupenic purpura is known as an autommune t,hrombocytopenic purpura. It is characterized by either an acute or gradual onset of petechiae or ecchymoses in the skin and mucous membranes, especially in the mouth. Epistaxis, conjunct.ival hemorrhage, hemorrhagic bullae in the mouth, gingival bleeding, melena, and hematemesis may occur. We report a case of idiopathic thrombocytopenic purpura in a 10-year-old male, who showed multiple petechiie and ecchymoses on both lower extremities, and hemorchagic bullae in the mouth. Periheral blood smear showed decreased platlet count, and in the bone marrow megakeyocytes were incraesed. Bleeding time was increased, but coagulation time was normal.
Bleeding Time ; Bone Marrow ; Child ; Ecchymosis ; Epistaxis ; Hematemesis ; Hemorrhage ; Humans ; Lower Extremity ; Male ; Melena ; Mouth ; Mucous Membrane ; Purpura ; Purpura, Thrombocytopenic, Idiopathic* ; Skin

Henoch-Schonlein purpura (HSP) is the most common form of systemic vasculitis in children. Palpable purpura, arthralgia, arthritis, abdominal pain and renal involvement are the major clinical manifestations. Gastrointestinal involvement is related with abdominal pain and bleeding. We described a 71 year-old female experienced acute exacerbation of HSP presented with gastrointestinal bleeding. She was hospitalized for hematemesis and diagnosed duodenitis by esophagogastroduonenoscopy (EGD). Duodenitis was improved at EGD checked in 7 days. She still complained of melena and abdominal pain. There were no abnormal findings at sigmoidoscopy. Jejunal ulcer and purpura were diagnosed by capsule endoscopy. Symptoms were relieved after administration of systemic steroid. But she needed renal replacement therapy for 3 months. Small bowel ulcer diagnosed by capsule endoscopy in patients with HSP was rarely described in Korean literature. This case suggests that capsule endoscopy have a role in diagnosis of small bowel ulcer and its severity in HSP with gastrointestinal symptom.
Abdominal Pain ; Arthralgia ; Arthritis ; Capsule Endoscopy ; Child ; Duodenitis ; Female ; Gastrointestinal Hemorrhage ; Hematemesis ; Hemorrhage ; Humans ; Melena ; Purpura ; Purpura, Schoenlein-Henoch ; Renal Replacement Therapy ; Sigmoidoscopy ; Systemic Vasculitis ; Ulcer

Hemorrhagic fever with renal syndrome frequently found in Korea is a acute infectious disease caused by Hantaan virus. Its clinical manifestations include high fever, cardiovascular collapse, hemorrhagic tendency and acute renal failure. Many patients with hemorrhagic fever with renal syndrome show hemorrhagic tendency such as subconjunctival hemorrhage and mucocutaneous petechia. In vital organs such as lung, kidney, spleen, brain, and pituitary, hemorrhage occasionally occurs spontaneously or by minor trauma. As a results, hematemesis, hemoptysis, melena and gross hematuria can be developed in some patients. Anemia and circulatory shock may result from large hematoma formed in third spaces like retroperitoneal and pleural space. But retroperitoneal hematoma and hemothorax was rarely reported. We report a case of hemorrhagic fever with renal syndrome complicated by retroperitoneal hematoma and hemothorax with review of literatures.
Acute Kidney Injury ; Anemia ; Brain ; Communicable Diseases ; Fever ; Hantaan virus ; Hematemesis ; Hematoma* ; Hematuria ; Hemoptysis ; Hemorrhage ; Hemorrhagic Fever with Renal Syndrome* ; Hemothorax* ; Humans ; Kidney ; Korea ; Lung ; Melena ; Shock ; Spleen

We observed clinically 150 cases who were admitted with complaing of purpura at the Pediatric Department of Severance Hospital Yonsei University College of Medicine during a period of 9 years from July, 1966 to June, 1975. In 150 cases, leukemia, 33 cases (22.0%), was most common disease, followed by I.T.P., allergic purpura, meningococcemia, aplastic a nemia, sepsis in order aqnd the incidence was 20.0% (30 cases), 19.3% (29 cases), 19.3% (29 cases), 14.0% (21 cases), 4.0% (6 cases) respectively. And we observed 1 case of thrombocytopenic purpura complicated with scarlet fever and primary hypersplenism respectively. The highest incidence was between the age of one and six years, and males were affected more frequently than females. Clinical manifestations were anemia, fever, abdominal pain, vomiting, joint pain in general symptoms and nasal bleeding, melena, gum bleeding in hemorrhagic symptoms. Major symptoms were fever, abdominal pain, anemia, na sal bleeding, melena, gum bleeding in thrombocytopenic purpura, and fever, abdominal pain, vomiting, meningeal irritation signs in non-thrombocytopenic purpura. I the laboratory findings, mean value of platelet count was below 40,000/mm(3) in thrombocytopenic purpura, but 190,000/mm(3) in non-thrombocytopenic purpura. And bleeding time was prolonged above 5 minutes in thrombocytopenic purpura, but was below 1 minute in non-thrombocytopenic purpura.
Abdominal Pain ; Anemia ; Arthralgia ; Bleeding Time ; Epistaxis ; Female ; Fever ; Gingiva ; Hemorrhage ; Humans ; Hypersplenism ; Incidence ; Leukemia ; Male ; Melena ; Platelet Count ; Purpura* ; Purpura, Schoenlein-Henoch ; Purpura, Thrombocytopenic ; Scarlet Fever ; Sepsis ; Vomiting

Diffuse alveolar hemorrhage is a very rare manifestation in Henoch-Schoenlein purpura. Recently we experience a case of diffuse alveolar hemorrhage associated with Henoch-Schoenlein purpura which was diagnosed by typical clinical manifestation and renal biopsy. A 25 year old male was admitted due to hemoptysis and dyspnea. Chest X-ray, HRCT and BAL revealed diffuse alveolar hemorrhage. He also had a history of skin rash, polyarthralgia, and hematochezia with abdominal pain. Renal biopsy which was taken for the evaluation of microscopic hematuria showed IgA nephropathy. Under the diagnosis of Henoch-Schoenlein purpura, we treated him with solumedrol pulse therapy, plasma-pheresis and prednisolone with cytoxan. After then he showed marked improvement in clinical manifestation and was discharged with prednisolone and cytoxan.
Abdominal Pain ; Arthralgia ; Biopsy ; Cyclophosphamide ; Diagnosis ; Dyspnea ; Exanthema ; Gastrointestinal Hemorrhage ; Glomerulonephritis, IGA ; Hematuria ; Hemoptysis ; Hemorrhage* ; Humans ; Male ; Methylprednisolone Hemisuccinate ; Prednisolone ; Purpura, Schoenlein-Henoch* ; Thorax

This is a clinical study on 72 cases of purpura hospitalized at Han Il Hospital during the period from Jan., 1970 to Dec, 1979. The authors obtained the following results : 1) Allergic purpura (25 cases, 34.7%) was the most common disease, followed by I.T.P. (20 cases, 27.8%), Ieukemia (10 cases, 13.9%), meningoccemia (7 cases, 9.7%), and aplastic anemia (5 cases, 6.9%) in order of frequency. 2) The most prevalent age group was 6 to 9 one (45 cases), and sex ratio of male to female revealed 1.67 : 1(45:27). 3) The main clinical features in thrombocytopenic purpura were anemia abdominal pain fever and epistaxis ; while those in non-thrombocytopenic purpura were abdominal pain fever melena hematuria and headache. 4) The hemoglobin level was below 7 gm.% in leukemia and aplastic anemia, but normal or slightly decreased in allergic purpura and idiopathic thrombocytopenic purpura. The W.B.C. count was markedly increased in the most cases of sepsis and leukemia, decreased in aplstic anemia, and within normal range in allergic purpura. The platelet count was below 10,000/mm2 in 97% cases of the thrombocytopenic purpura, while within normal range in non-thrombocytopenic purpura. 5) The bleeding time and the clotting time were within normal ranges in most of all cases. The Rumpel-Leede test revealed positive result in 85% cases of I.T.P., while in only 20% of allergic purpura.
Abdominal Pain ; Anemia ; Anemia, Aplastic ; Bleeding Time ; Child* ; Epistaxis ; Female ; Fever ; Headache ; Hematuria ; Humans ; Leukemia ; Male ; Melena ; Platelet Count ; Purpura* ; Purpura, Schoenlein-Henoch ; Purpura, Thrombocytopenic ; Purpura, Thrombocytopenic, Idiopathic ; Reference Values ; Sepsis ; Sex Ratio

This is a clinical study on 72 cases of purpura hospitalized at Han Il Hospital during the period from Jan., 1970 to Dec, 1979. The authors obtained the following results : 1) Allergic purpura (25 cases, 34.7%) was the most common disease, followed by I.T.P. (20 cases, 27.8%), Ieukemia (10 cases, 13.9%), meningoccemia (7 cases, 9.7%), and aplastic anemia (5 cases, 6.9%) in order of frequency. 2) The most prevalent age group was 6 to 9 one (45 cases), and sex ratio of male to female revealed 1.67 : 1(45:27). 3) The main clinical features in thrombocytopenic purpura were anemia abdominal pain fever and epistaxis ; while those in non-thrombocytopenic purpura were abdominal pain fever melena hematuria and headache. 4) The hemoglobin level was below 7 gm.% in leukemia and aplastic anemia, but normal or slightly decreased in allergic purpura and idiopathic thrombocytopenic purpura. The W.B.C. count was markedly increased in the most cases of sepsis and leukemia, decreased in aplstic anemia, and within normal range in allergic purpura. The platelet count was below 10,000/mm2 in 97% cases of the thrombocytopenic purpura, while within normal range in non-thrombocytopenic purpura. 5) The bleeding time and the clotting time were within normal ranges in most of all cases. The Rumpel-Leede test revealed positive result in 85% cases of I.T.P., while in only 20% of allergic purpura.
Abdominal Pain ; Anemia ; Anemia, Aplastic ; Bleeding Time ; Child* ; Epistaxis ; Female ; Fever ; Headache ; Hematuria ; Humans ; Leukemia ; Male ; Melena ; Platelet Count ; Purpura* ; Purpura, Schoenlein-Henoch ; Purpura, Thrombocytopenic ; Purpura, Thrombocytopenic, Idiopathic ; Reference Values ; Sepsis ; Sex Ratio

Congenital factor V deficiency is a rare coagulation disorder, which is genetically autosomal recessive. In 1947, Owren first described a case of parahemophilia. During childhood, ecchymosis (bruising), epistaxis, oral hemorrhage, soft-tissue hemorrhage, and postpartum hemorrhage are noted in half of the patients. Because factor V is involved in common pathway in the coagulation scheme, prothrombin time (PT) and partial thromboplastin time (PTT) are prolonged. Definite diagnosis can be made with a specific factor V assay. Fresh frozen plasma would appear to be the treatment of choice. For the first time in Korea, we experienced a case of vaginal delivery in a patient with factor V deficiency. She delivered a male baby weighing 3120gm with median episiotomy. Six units of fresh frozen plasma were transfused during delivery. After additional transfusions of fresh frozen plasma, she was discharged on fourth postpartum day without hemorrhage or hematoma.
Diagnosis ; Ecchymosis ; Episiotomy ; Epistaxis ; Factor V Deficiency* ; Factor V* ; Female ; Hematoma ; Hemorrhage ; Humans ; Korea ; Male ; Oral Hemorrhage ; Partial Thromboplastin Time ; Plasma ; Postpartum Hemorrhage ; Postpartum Period ; Prothrombin Time

PURPOSE: The aim of this study is to investigate the usefulness of intestinal ultrasonography (US) and upper gastrointestinal endoscopy in the early diagnosis of Henoch-Schonlein purpura (HSP) with the gastrointestinal (GI) symptoms preceding the emergence of the skin lesion. METHODS: The clinical, intestinal US and upper gastrointestinal endoscopic records of 85 patients (88 cases) with GI symptoms relating to HSP presenting between January 1999 and April 2001 were reviewed. RESULTS: 1) GI symptoms were observed in 52 cases (59%) and skin, joint, renal and scrotal manifestations were observed in 88 (100%), 64 (73%), 15 (17%), 3 cases (3%) respectively. 2) Out of 52 cases with GI symptoms, abdominal pain was observed in all cases (100%). Positive stool occult blood, nausea and vomiting, abdominal tenderness, melena or tarry stool, diarrhea, hematemesis, rebound tenderness and rigidity were observed in 28 (50%), 17 (33%), 17 (33%), 12 (23%), 6 (12%), 4 (8%), 1 (2%) and 1 case (2%) respectively in order of frequency. 3) Intestinal US examination was performed in 27 cases with HSP and GI symptoms (52 cases). Out of 27 sonographic examinations 22 showed abnormal findings. Thickening of the duodeno-jejunal wall was observed in 16 cases (73%). Free peritoneal fluid, enlarged mesenteric lymph node, ileus and abnormal gall bladder were seen in 8 (36%), 8 (36%), 4 (18%) and 1 case (5%) respectively. In three cases of HSP without GI symptoms, those changes were absent. 4) In all of five cases with HSP and GI symptoms, endoscopic study showed mucosal edema and multiple hemorrhagic erosions especially at the second portion of the duodenum. Biopsy specimens from the duodenum of 2 cases out of 5 endoscopic examinations showed acute inflammatory infiltrates in the mucosa with hemorrhage. 5) Both intestinal US and endoscopic studies were performed in 4 cases with HSP and GI symptoms simultaneously. Out of 4 those cases, 3 cases showed the thickened duodeno-jejunal wall on the intestinal US, which suggested erosive hemorrhagic duodenitis by endoscopic findings. CONCLUSION: The typical but nonpathognomonic intestinal US findings including the thickening of the duodeno-jejunal wall and upper gastrointestinal endoscopic findings including hemorrhagicerosive duodenitis, in children with GI symptoms, should be considered a manifestation of HSP, even in the absence of skin lesion.
Abdominal Pain ; Ascitic Fluid ; Biopsy ; Child ; Diarrhea ; Duodenitis ; Duodenum ; Early Diagnosis ; Edema ; Endoscopy ; Endoscopy, Gastrointestinal ; Hematemesis ; Hemorrhage ; Humans ; Ileus ; Joints ; Lymph Nodes ; Melena ; Mucous Membrane ; Nausea ; Occult Blood ; Purpura, Schoenlein-Henoch* ; Skin ; Ultrasonography ; Urinary Bladder ; Vomiting

The majority of cases of duodenal intramural hematoma occur in children due to blunt abdominal trauma. In adult patients, the etiology of hematoma is quite varied. A hematoma may occur due to the usage of anticoagulants, hemophilia, Henoch-Schonlein purpura, vasculitis, pancreatic disease, endoscopic coagulation of duodenal ulcer bleeding and following an endoscopic retrograde cholangiopancreatogram. A 53-year-old male patient was admitted for hematemesis. The patient was a heavy alcoholic and had a history of chronic pancreatitis, but there was no definite trauma history or other medical illness. In the duodenal second portion, a huge submucosal mass obstructed the lumen with submucosal hemorrhage. As depicted on an abdominal CT and an endoscopic ultrasonogram, chronic pancreatitis and a duodenal submucosal tumor was suspected. On the eighth hospital day, abdominal pain suddenly became worse and peritoneal-irritation signs were observed. Therefore, a surgical procedure was urgently performed. Considering the rarity of its etiology in Korea, we report a case of duodenal intramural hematoma complicated with chronic pancreatitis.
Abdominal Pain ; Adult ; Alcoholics ; Anticoagulants ; Child ; Duodenal Ulcer ; Hematemesis ; Hematoma ; Hemophilia A ; Hemorrhage ; Humans ; Korea ; Male ; Middle Aged ; Pancreatic Diseases ; Pancreatitis ; Pancreatitis, Chronic ; Purpura, Schoenlein-Henoch ; Vasculitis