We compared the production of three chemokines; interferon-gamma-inducible protein-10 (IP-10), monocyte chemoattractant protein-1 (MCP-1) and growth-related onco-gene-alpha(Gro-alpha) that attracts monocytes or neutrophils, or both, in peripheral blood at acute stage of Kawasaki disease (n=29), Henoch-Schonlein purpura (n=15) and acute febrile illnesses (n=12). The production of the chemokines was assayed by ELISA. The plasma levels of IP-10 were markedly elevated in Kawasaki disease (538.6 +/-336.4 pg/mL) and acute febrile illnesses (417.1 +/-262.2 pg/mL) compared with in Henoch-Schonlein purpura (58.7 +/-95.7 pg/mL) (p<0.05). The MCP-1 levels were elevated in Kawasaki disease (443.0 +/-473.1 pg/mL) and acute febrile illnesses (328.6 +/-261.1 pg/mL) compared with in Henoch-Schonlein purpura (82.9 +/-79.0 pg/mL) (p<0.05). The Gro- levels were elevated only in acute febrile illnesses (134.3 +/-153.6 pg/mL) compared with in Kawasaki disease (31.8 +/-22.1 pg/mL) or Henoch-Schonlein purpura (29.4 +/-53.3 pg/mL) (p<0.05). According to these results, monocytes may play an important role in Kawasaki disease. In acute febrile illness-es, both monocytes and neutrophils may play an important role. By contrast, Henoch-Schonlein purpura may not be associated with the role of monocytes and neutrophils. Further studies using a larger number of cases are needed.
Acute Disease ; Adolescent ; Chemokines/*blood ; Child ; Child, Preschool ; Comparative Study ; Female ; Fever/*blood/*epidemiology ; Humans ; Infant, Newborn ; Korea/epidemiology ; Male ; Mucocutaneous Lymph Node Syndrome/*blood/*epidemiology ; Purpura, Schoenlein-Henoch/*blood/*epidemiology ; Research Support, Non-U.S. Gov't ; Risk Assessment/methods ; Risk Factors

We aimed to investigate differences in clinical manifestations and outcomes between adult and child patients with Henoch-Schonlein purpura (HSP), and to analyze the factors associated with poor prognosis for HSP nephritis. This retrospective 10-yr study enrolled 160 patients with HSP who visited Severance Hospital. Purpura was mostly detected in lower extremities, but purpura in upper extremities was more frequently observed in adults than children (41.7% vs 19.3%). Children had a greater frequency of arthralgia (55.4% vs 27.1%), while adults had a greater frequency of diarrhea (20% vs 1.6%). Anemia, elevated C-reactive protein, and level of IgA were more frequently observed in adults (25% vs 7.1%, 65.6% vs 38.4%, 26.3% vs 3.5%). Renal involvement in adults was more severe than in children (79.2% vs 30.4%). Chronic renal failure showed a significant difference in outcomes of HSP between adults (10.4%) and children (1.8%) after a follow up period of an average of 27 months. Furthermore, renal insufficiency at diagnosis was significantly related to the progression to chronic renal failure. Our results showed several differences in the clinical features of HSP between adults and children. Adults with HSP had a higher frequency of renal insufficiency and worse renal outcomes than children. Renal insufficiency at diagnosis might be of predictive value for the progression to chronic renal failure in HSP patients.
Adult ; Aged ; Aged, 80 and over ; Arthralgia/epidemiology/etiology ; C-Reactive Protein/analysis ; Child ; Child, Preschool ; Diarrhea/epidemiology/etiology ; Extremities/pathology ; Female ; Follow-Up Studies ; Humans ; Immunoglobulin A/blood ; Immunosuppressive Agents/therapeutic use ; Infant ; Middle Aged ; Odds Ratio ; Prognosis ; Purpura, Schoenlein-Henoch/complications/*diagnosis/drug therapy/*pathology ; Renal Insufficiency/epidemiology/etiology ; Retrospective Studies ; Young Adult

BACKGROUND: Henoch-Schonlein purpura is a relatively common dermatological disease involving multisystems such as the skin, gastrointestinal tract, joints, kidnies. there have been several reports on the epidemiological study of Henoch-Schonlein purpura in Korea. However, there has not been any report on the clinical analysis of Henoch-Schonlein purpura in domestic dermatological journals. OBJECTIVE: The aim of this study was to analyze clinical symptoms of Henoch-Schonlein purpura defined by strict application of the American College of Rheumatology 1990 criteria with a dermatologist's point of view. METHODS: The authors analyzed retrospectively 60 cases of Henoch-Schonlein purpura selected by age(< 20) and histopathological findings of the skin showing leukocytoclastic vasculitis or granulocytes in the wall of small vessels among the 137 patients hospitalized with Henoch-Schonlein purpura at Keimyung University Hospital from March, 1993 to February, 1998. RESULTS: 1. It was observed more frequently in males as the sex ratio of 1.6:1. The most prevalent age group was 5 to 7-year-olds(36.7%) and children of 2 to 10-year-old represented 66.7% of the total cases. 2. In seasonal incidence, the cases were frequent during autumn(34%) and winter(25%). 3. No specific history was noted in 22 cases(37%). The main specific histories were upper respiratory tract infections(32%) and drugs(12%). 4. The clinical manifestations showed in the skin(100%), the gastrointestinal tract(52%), the joints (43%), kidnies(27%) respectively. 1) The common manifestation in the skin was purpuric papule and petechiae(97%) and the lower extremities were involved in all cases. Moreover, the lower extremities and buttocks were the most common involved sites. 2) As for the gastrointestinal symptoms, abdominal pain was noted in all cases and others were occult blood(52%), nausea(23%), diarrhea(6%) and melena(6%). Abnormal gastrointestinal endoscopic findings were noted in 28 cases(90%) and duodenum was involved in 93% of 28 cases. 3) Arthralgia was observed on the knee joint(65%), ankle joint(50%), elbow joint(15%). More than 2 joints were involved in 38% of cases. 4) Renal manifestations were proteinuria(94%), microscopic hematuria(81%), gross hematuria(19%) and hypertension(2%). A Renal biopsy done in 2 cases revealed mesangial proliferative glomerulonephritis with the deposition of IgA. 5. Platelet count and blood coagulation tests were within normal ranges. Observed abnormal laboratory findings were leukocytosis(70%), increased ESR(77%), elevated ASO titer(37%), elevated serum IgA(50%), elevated C3(38%), positive antinuclear antibody(10%). There was no statistical significance between the renal involved group and the non-involved group in terms of ASO titer and serum IgA(p> 0.05). 6. Skin, abdominal and joint manifestations recovered within 1 month except 1 case with skin involvement. Among the 16 cases with renal involvement, 10 cases(62%) recovered within 2 months and 2 cases(13%) showed persistent symptoms over 1 year. One case progressed to nephrotic syndrome. CONCLUSION: Most of our results were similar with previous reports and the prognosis of Henoch-Schonlein purpura was good. In some cases, gastrointestinal endoscopy may be helpful for evaluating the bowel manifestation and early diagnosis. Because the long-term prognosis for patients with renal involvement depends on the initial clinical presentation, early diagnosis and prompt proper management through cooperation with other departments is important and long-term follow-up is necessary even if clinical manifestations are recovered, especially in patients with renal involvement.
Abdominal Pain ; Ankle ; Arthralgia ; Biopsy ; Blood Coagulation Tests ; Buttocks ; Child ; Duodenum ; Early Diagnosis ; Elbow ; Endoscopy, Gastrointestinal ; Epidemiologic Studies ; Epidemiology ; Follow-Up Studies ; Gastrointestinal Tract ; Glomerulonephritis ; Granulocytes ; Humans ; Immunoglobulin A ; Incidence ; Joints ; Knee ; Korea ; Lower Extremity ; Male ; Nephrotic Syndrome ; Platelet Count ; Prognosis ; Purpura, Schoenlein-Henoch* ; Reference Values ; Respiratory System ; Retrospective Studies ; Rheumatology ; Seasons ; Sex Ratio ; Skin ; Vasculitis