Henoch-Schonlein purpura (H-S purpura) is a systemic small-vessel vasculitis involving skin, joint, gastrointestinal tract, and kidney. It is characterized by the classic tetrad of abdominal pain, arthralgia, typical rash, and renal involvement. All of these clinical findings can occur in any order and at any time over several days to weeks. Gastrointestinal manifestations such as abdominal pain, melena, or hematochezia occur in 45-85% and preceed skin lesions upto 40% in H-S purpura. However, endoscopically proven gastrointestinal lesion is rare because majority of involved sites are small intestine. We report a case of Henoch-Schonlein purpura with terminal ileal ulcer, healed after treatment with high dose steroid, proven by colonoscopy.
Adult ; Anti-Inflammatory Agents/*therapeutic use ; Colonoscopy ; Humans ; Ileal Diseases/*drug therapy/etiology/pathology ; Leg/pathology ; Male ; Prednisolone/*therapeutic use ; Purpura, Schoenlein-Henoch/complications/*diagnosis/drug therapy ; Ulcer/*drug therapy/etiology/pathology

Henoch-Schonlein purpura (HSP) is common in childhood and often self-limiting. There have been limited studies on elderly-onset HSP nephritis (HSPN). A 76-yr-old man was transferred to our hospital with a 1-month history of oliguria, abdominal pain, edema and palpable purpura in the legs. Three months ago, he was admitted to another hospital with jaundice, and consequently diagnosed with early common bile duct cancer. The patient underwent a Whipple's operation. Antibiotics were administrated because of leakage in the suture from the surgery. However, he showed progressive renal failure with edema and purpura in the legs. Laboratory investigations showed serum creatinine 6.4 mg/dL, 24-hr urine protein 8,141 mg/day, myeloperoxidase anti-neutrophil cytoplasmic antibodies (MPO-ANCA) 1:40 and C3 below 64.89 mg/dL. Renal biopsy showed crescentic glomerulonephritis, as well as mesangial and extracapillary Ig A deposition. We started steroid therapy and hemodialysis, but he progressed to end-stage renal failure and he has been under maintenance hemodialysis. We describe elderly onset HSPN with MPO-ANCA can be crescentic glomerulonephritis rapidly progressed to end stage renal failure.
Aged ; Antibodies, Antineutrophil Cytoplasmic/*analysis ; Common Bile Duct Neoplasms/complications/surgery ; Complement C3/analysis ; Creatinine/blood ; Edema/drug therapy ; Enzyme-Linked Immunosorbent Assay ; Glomerulonephritis/pathology ; Humans ; Male ; Purpura, Schoenlein-Henoch/*diagnosis/drug therapy ; Renal Dialysis ; Renal Insufficiency/etiology/pathology ; Steroids/therapeutic use

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