scholarly journals P027 A case of Henoch-Schonlein purpura complicated by adrenal haemorrhage

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Joyce G C Shek ◽  
Maja Curuvija ◽  
Shibeb Al-Mudhaffer ◽  
Gautam Das ◽  
Emyr P M Humphreys
Keyword(s):  
Blood Pressure ◽  
Abdominal Pain ◽  
Clinical Signs ◽  
Complement C3 ◽  
Full Blood Count ◽  
Adrenal Haemorrhage ◽  
Henoch Schonlein Purpura ◽  
Schonlein Purpura ◽  
Purpuric Rash ◽  
Henoch Schönlein Purpura

Abstract Background/Aims  Henoch-Schonlein purpura (HSP) is a small vessel vasculitis characterised by IgA deposition. Adrenal haemorrhage has been reported previously in HSP, but is rare. Methods  A 33-year-old lady was admitted with myalgia, pyrexia, a faint petechial rash on her legs, a CRP of 92mg/L (<5). No signs of meningism were found. A throat swab for viral pathogens (taken prior to the Covid-19 pandemic) returned negative, and blood culture showed no growth. Within a few days she returned to the Accident & Emergency Department with worsening of the rash but was again discharged. The following week she was admitted with abdominal pain and a prominent purpuric rash on her legs. Results  Full blood count, Rheumatoid Factor, Anti-Nuclear Antibodies, ANCA and Anti-Glomerular Basement Membrane Antibodies, serum Tryptase & C1 esterase inhibitor were all within normal limits. Urine culture grew E.coli. Complement C3 was raised at 2.24 g/L (0.75-1.65) and C4 was within normal range. Her blood pressure was raised at 173/104 mmHg. Antistreptolysin O serology was also normal. Urine analysis revealed haematuria and mild proteinuria. Urine Protein:Creatinine ratio of 22mg/mmol (normal <50). Her purpuric rash had progressed, and she had further abdominal pain. She had taken co-codamol which led to nausea & constipation. She had avoided NSAIDs. Her CRP by this stage was 131mg/L. Clinically the rash on the legs, abdominal pain and haematuria was consistent with HSP. She was started on Prednisolone 10mg od, tapering in 2.5mg per week decrements. The patient was discharged home but returned the following weekend with cramping abdominal pain radiating to the back. Abdominal Xray showed dilated colon at the splenic flexure. After review by the Surgical on call team, a CT Abdomen & Pelvis showed a right adrenal haemorrhage, and inflammatory change in both adrenals. Although she did not display clinical signs of Addisonian crisis or sepsis, she was transferred to HDU for monitoring. Her blood pressure was 151/86 mmHg and her serum urea & electrolytes were normal. The Prednisolone dose was changed to Hydrocortisone, and the dose increased to cover stress of acute illness. MRI of the adrenal glands confirmed right adrenal haemorrhage but showed no evidence of aneurysms or tumours. Antiphospholipid & Cryoglobulins screens were negative. Further blood cultures, pneumococcal and legionella antigens returned negative. Viral Hepatitis screen (A, B & E) was negative. Synacthen test revealed a suboptimal response (Cortisol t0=181nmol/L, t30=260nmol/L, normal response >420nmol/L). Adrenal Autoantibodies returned negative. She was discharged home on oral hydrocortisone and fludrocortisone and remained well at Rheumatology and Endocrine follow up. Conclusion  Adrenal haemorrhage is a rare complication of HSP and should be considered as part of the differential diagnosis in such patients presenting with acute abdominal pain and vasculitic rash. Disclosure  J.G.C. Shek: None. M. Curuvija: None. S. Al-Mudhaffer: None. G. Das: None. E.P.M. Humphreys: Honoraria; E.H. has participated in advisory board meetings for Pfizer. Other; E.H. has received sponsorship to attend conferences from Abbvie, UCB and Celgene.

scholarly journals A Rare Case of Henoch-Schönlein Purpura Following a COVID-19 Vaccine—Case Report

2021 ◽  
Author(s):  
Abdelhamid Naitlho ◽  
Wahib Lahlou ◽  
Abderrahim Bourial ◽  
Hamza Rais ◽  
Nabil Ismaili ◽  
...  
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Rare Case ◽  
Clinical Signs ◽  
Henoch Schonlein Purpura ◽  
Old Adult ◽  
Schonlein Purpura ◽  
Purpuric Rash ◽  
Henoch Schönlein Purpura ◽  
Rapid Regression

AbstractIn the COVID-19 pandemic era, anti-SARS-CoV-2 vaccination is considered to be the most efficient way to overtake the COVID-19 scourge. Like all medicines, vaccines are not devoid of risks and can in rare cases cause some various side effects. The objective of this case report is to highlight this unusual presentation of Henoch-Schönlein purpura following an anti-COVID-19 vaccination in a 62-year-old adult. The 62-year-old patient admitted to the emergency room for a petechial purpuric rash, sloping, occurring within hours, involving both legs and ascending. The clinical signs also included polyarthralgia and hematuria. Reported in the history the notion of an anti-COVID-19 vaccination 8 days prior to the onset of symptomatology. In the case of our patient, we retain the diagnosis of rheumatoid purpura based on the EULAR/PRINTO/PReS diagnostic criteria. Corticosteroid therapy (prednisone) was started, resulting to a rapid regression of clinical and laboratory symptoms, few days after the treatment. Patient was asymptomatic on subsequent visits. The low number of published cases of post-vaccine vasculitis does not question the safety of vaccines, but knowledge of such complications deserves to be known in order to avoid new immunizations that could have more serious consequences, and to avoid aggravating or reactivating a pre-existing vasculitis.

scholarly journals HENOCH-SCHÖNLEIN PURPURA Z NEZNAČILNIM POTEKOM BOLEZNI – predstavitev treh primerov in pregled literature

2016 ◽  
Vol 85 (2) ◽  
Author(s):  
Daša Kumprej ◽  
Tomaž Krenčnik ◽  
Aleksandra Aleksandrova Oberstar ◽  
Nataša Toplak
Keyword(s):  
Abdominal Pain ◽  
Renal Disease ◽  
Blood Vessels ◽  
Current Literature ◽  
Atypical Presentation ◽  
Disease Course ◽  
Henoch Schonlein Purpura ◽  
Skin Manifestation ◽  
Schonlein Purpura ◽  
Henoch Schönlein Purpura

Background: Henoch-Schönlein purpura is the most common vasculitis of small blood vessels in children. The diagnosis of the disease is confirmed in a patient with a specific rash, joint inflamation, abdominal pain or renal disease. The specific rash is necesary for the confirmation of the diagnosis. Henoch-Schönlein purpura can rarely present with a complication withot a prior presentation of the rash. In these cases diagnosis is difficult until the presentation of the specific skin manifestation. In the majority of patients the disease course is not complicated and has a good prognosis.Conclusion: In this article we present three patients with an atypical presentation of the disease and a review of current literature on the topic.

Steroid Effects on the Course of Abdominal Pain in Children With Henoch-Schonlein Purpura

PEDIATRICS ◽  
1987 ◽  
Vol 79 (6) ◽  
pp. 1018-1021
Author(s):  
NORMAN D. ROSENBLUM ◽  
HARLAND S. WINTER
Keyword(s):  
Abdominal Pain ◽  
Gastrointestinal Symptom ◽  
Systemic Vasculitis ◽  
Skin Lesions ◽  
Intestinal Bleeding ◽  
Controlled Trials ◽  
Henoch Schonlein Purpura ◽  
Intestinal Lesions ◽  
Schonlein Purpura ◽  
Henoch Schönlein Purpura

Henoch-Schonlein purpura is a systemic vasculitis of unknown cause that is characterized primarily by abdominal pain, arthritis, and purpuric skin lesions. Abdominal pain is the most common gastrointestinal symptom, but intestinal bleeding and intussusception may occur. Previous studies have supported the use of steroids in managing the abdominal pain of Henoch-Schonlein purpura.1,2 Because there are no controlled trials using steroids in this disease, their value in affecting the intestinal lesions of Henoch-Schonlein purpura remains unknown. The purpose of this retrospective study was to assess the effect of corticosteroids on the outcome of abdominal pain in children with Henoch-Schonlein purpura. PATIENTS AND METHODS

Adult Henoch-Schönlein Purpura with Severe Abdominal Pain Treated with Dapsone and Factor XIII Concentrate

2005 ◽  
Vol 32 (2) ◽  
pp. 124-127 ◽  
Author(s):  
Naoko Shimomura ◽  
Kazuhiro Kawai ◽  
Shiro Watanabe ◽  
Kaoru Katsuumi ◽  
Masaaki Ito
Keyword(s):  
Abdominal Pain ◽  
Factor Xiii ◽  
Severe Abdominal Pain ◽  
Henoch Schonlein Purpura ◽  
Schonlein Purpura ◽  
Henoch Schönlein Purpura

scholarly journals Why does Mycophenolate use only for kidney complications in Schonlein Henoch Syndrome? Case report

2020 ◽  
Author(s):  
Maria Francesca Gicchino ◽  
Dario Iafusco ◽  
Maria Maddalena Marrapodi ◽  
Rosa Melone ◽  
Giovanna Cuomo ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Mycophenolate Mofetil ◽  
Immunosuppressive Agents ◽  
Renal Involvement ◽  
Lower Extremities ◽  
Gastrointestinal Involvement ◽  
Henoch Schonlein Purpura ◽  
Cutaneous Manifestations ◽  
Schonlein Purpura ◽  
Henoch Schönlein Purpura

Abstract Background : Henoch Schonlein purpura (HSP) is an acute small vessel vasculitis. It is the most common vasculitis in children. Although the cause is unknown, IgA seems to play a central role in the pathogenesis of Henoch Schonlein purpura. The major clinical features include a palpable purpuric rash on the lower extremities, abdominal pain or renal involvement, and arthritis. Cutaneous manifestations are the essential elements in the diagnosis of Henoch Schonlein purpura. The palpable purpura is characteristically 2 to 10mm in diameter and is usually present on the lower extremities. There are no specific diagnostic tests available for diagnosing this condition. Laboratory studies are useful to exclude other conditions that may mimic Henoch Schonlein purpura. In majority of the cases, the disease is self-limited. Relapsing can occur, in particular during the first year of the disease. There is no consensus on a specific treatment. Corticosteroids are effective in rapid resolution of renal and abdominal manifestations. Immunosuppressive drugs, such as Mycophenolate Mofetil may be a better treatment choice in case of renal involvement.Case report : We report a case of a 14 years old girl affected from recurrent Henoch Schonlein Purpura. From the age of nine years patient presented three episodes of purpura with gastrointestinal involvement, in particular hematemesis, abdominal pain and diarrhoea. Each episode was treated with high doses of corticosteroids (methylprednisolone in vein or prednisone per os). Patient came to our Department during the third episode of Purpura. In consideration of the recurrence of the Henoch Schonlein Purpura and the gastrointestinal involvement we decided to start Mycophenolate Mofetil treatment. Patient’s conditions improved thanks to Mycophenolate Mofetil treatment. Conclusion: In our case of recurrent HSP Mycophenolate Mofetil treatment has been very effective, avoiding the adverse events of a prolonged steroid treatment. This experience teaches us that immunosuppressive agents may be very useful to induce and maintain remission not only in renal involvement, but in all cases of persistence, recurrence or complicated forms of Henoch Schonlein purpura in children.

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