Henoch-Schönlein purpura

Henoch-Schönlein purpura commonly occurs in children at about age five. There is no known etiologic agent. The illness is characterized by skin rash, joint pain, edema and gastrointestinal symptoms. Laboratory tests are not diagnostic. Although there is no specific treatment, steroids may help prevent serious gastrointestinal complications. Prognosis is good, except for those patients with advancing renal disease.

[Cryoglobulinemia, hemorrhagic vasculitis skin changes in hepatopathy]

Cryoglobulins in the blood of patients with liver diseases may be associated with immunologically induced cutaneous vasculitis and haemorrhage. A personal case of chronic cirrhogenic liver disease with progression to liver insufficiency is presented. The picture included IgG, IgA and IgM cryoglobulinaemia and palpable purpura. The main features of primary and secondary or symptomatic cryoglobulinaemia are described, and an account is given of the mostly recent literature on the association between cryoglobulinaemia and liver diseases. Its pathogenesis and possible forms of treatment are also discussed.

Henoch-Schönlein purpura after yersiniosis

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Schönlein-Henoch syndrome in patients with familial Mediterranean fever

Ten episodes of Schönlein-Henoch purpura (SHP) in 8 patients with familial Mediterranean fever (FMF) were observed. Five episodes developed 3-14 days after penicillin injections, suggesting an etiologic association. FMF and SHP have clear clinical similarities, and if the frequency of association of the 2 diseases is indeed high, perhaps a common etiologic factor should be sought. An immune complex mechanism might be the link between these 2 disease entities.

[Allergic vascularities with clinical skin manifestations]

After describing the cutaneous and histo-pathological symptoms of allergic vasculazities, the author describes: Gougerot's tri-symptomatic disease, its differential diagnoses, and its various aetiologies. The pathology of the latter leads us to consider immune complexes, but our study does not deal with it in detail. Purpura rheumatica produces gammaglobulins A. Urticarial vasculazities may or may not be accompanied by anomalies of the complementary system; they may be transposed auto-immune disorders such as lupus erythematosus; their development is fairly unpredictable., Acute hemorrhagic oedema of the skin of nurslings also has allergic vasculazities at its basis. The author also mentions the transitory state between these different pictures, notably polyarteritis nodosa, granulomatotic pulmonary angitis of Churg and Strauss, and Wegener's granulomatosis.

Circulating IgA-immune complexes in Henoch-Schönlein purpura. A longitudinal study of their relationship to disease activity and vascular deposition of IgA

In Henoch-Schönlein purpura immune complexes in inflamed vessel walls characteristically contain immunoglobulin A(IgA). To determine whether IgA is also the predominant immunoglobulin in circulating immune complexes, we compared the results of three immune complex assays with specificities for different classes of immunoglobulins in a longitudinal study of 37 patients (30 children and seven adults) with Henoch-Schönlein purpura. Circulating IgA-containing immune complexes were detected by their reactivity with a low avidity anti-IgA antibody in 27 of the 37 patients. IgA was simultaneously present in cutaneous vessel walls in 95 percent of the patients with circulating IgA-containing immune complexes. High levels of IgA-containing immune complexes were found only during the initial phase of the disease. Immune complexes containing bound complement breakdown products were demonstrated by binding to conglutinin. IgA was found in these immune complexes in 17 patients, IgG in 17 and IgM in nine patients. There was no apparent relation with the class of immunoglobulin in the deposits. Conglutinin-binding immune complexes were present later in the course of the disease and after remission. C1q-binding immune complexes were only found in two patients. These findings suggest that immune complexes-containing IgA may initiate the vasculitis of Henoch-Schönlein purpura, whereas complement-reacted immune complexes containing immunoglobulins of the other classes appear in the circulation in a later phase.

Hemorrhagic fevers, with special reference to recent outbreaks in southern Africa

In considering the diagnosis of a patient admitted to the Johannesburg Hospital, suffering from an illness characterized by high fever and complicated by a hemorrhagic state from which he died, a list of possible causes of his illness was drawn up. This list included the arthropodborne viral infections prevalent in southern Africa, namely, chikungunya fever, Sindbis fever, West Nile fever, yellow fever, and Rift Valley fever; viral infections associated with rodents, such as Lassa fever; the viral infection associated with monkeys, Marburg virus disease; the rickettsial infections; tick-bite fever (the variety of spotted fever of tick typhus occurring in southern Africa) and Q fever; the bacterial infections, especially the coccal infections, plague septicemia, and meningococcal, staphylococcal, and streptococcal septicemia; and the blood protozoal infections malaria and trypanosomiasis. In addition, rubella, Gasser's syndrome, Henoch-Schönlein purpura, and viperine snakebite were briefly described in this review. All of these conditions may be complicated by the development of a hemorrhagic state. The circulation of large numbers of infecting organisms, by they viruses, rickettsiae, bacteria, or protozoa, may initiate the coagulation cascade, the formation of fibrin and its deposition in the finer blood vessels, and the aggregation and entanglement of platelets resulting in marked thrombocytopenia and bleeding. This bleeding tendency is greatly aggravated when the infection specifically involves the parenchymal cells of the liver; such a condition results in defective formation of coagulation factors such as prothrombin. The proper care of patients in whom a hemorrhagic state has developed requires urgent and accurate diagnosis followed by immediate and appropriate treatment that will combat the infection and alleviate the hemorrhagic state and liver disorder. If the hemorrhagic state is due to one of the dangerous infectious fevers, adequate protection of the medical, nursing, and laboratory staff concerned is also vital.

Cryofibrinogenemia in Henoch-Schönlein purpura: report of a case

A patient with Henoch-Schönlein purpura (HSP) had exacerbations of disease that correlated closely with the presence of cryofibrinogenemia. Cryofibrinogen was absent consistently during asymptomatic intervals. To our knowledge, such a pattern has not been described previously in typical HSP. We suggest that all patients with HSP be screened for cryofibrinogenemia during the active phase of disease to determine the incidence of this abnormality.

Small vessel vasculitis caused by hepatitis B virus immune complexes. Small vessel vasculitis and HBsAG

In a comprehensive study of 80 patients with vasculitis, 4 had concurrent hepatitis B virus (HBV) infection. Polyarteritis nodosa was present in 2 and in the other 2, cutaneous vasculitis, presenting clinically as palpable or Henoch-Schönlein purpura. In one of these patients skin biopsies demonstrated granular deposits of IgM, C3, C4, and the hepatitis B surface antigen (HBsAg) and electron-dense deposits of aggregated 20-nm particles resembling HBsAg in postcapillary venules. Evidence for circulating HBsAg-immune complexes included increased serum Clq binding activity, decreased serum complement, and a cryoprecipitate containing both HBsAg and IgM anti-HBs. Aggregated 20-nm particles resembling intact HBsAg were also seen by negative staining electron microscopy of the serum cryoprecipitate. This patient fulfills all the criteria for a specific immune complex vasculitis caused by his immune response to a chronic HBV infection. These findings emphasize that HBV infection may be associated with small vessel vasculitis as well as polyarteritis nodosa, mixed cryoglobulinemia, and glomerulonephritis. A similar immune response to other viral infections may be expressed as palpable (Henoch-Schönlein) purpura also.

Cutaneous necrotizing vasculitis and related disorders

Leukocytoclastic vasculitis of the skin comprises several distinct clinical syndromes, each with immune complex deposition and some form of complement activation. Necrotizing vasculitides of larger blood vessels also produce skin lesions. These can be distinguished morphologically from those of small vessel vasculitis. Analysis of the features of these lesions is discussed.

The tourniquet test as a diagnostic aid for the study of telangiectasia

Telangiectasia, commonly called Rendu-Osler disease, in its uncomplicated state is a genetic trait, not a disease, which is transmitted as a dominant. It is difficult to diagnose because the identifying characteristics, which are collectively called telangiectases, are multiform. They often do not appear until adult life and frequently are secondary to extraneous or environmental factors such as alcohol, various drugs of which aspirin is an example, and, in a few subjects, exposure to sunlight. The tourniquet test is positive in a high percentage of cases. Eight patients have been selected for discussion to illustrate the application and helpfulness of this test in attaining a better evaluation of the clinical aspects of telangiectasia.

[ASLO levels in 1174 patients admitted to the Turin University Paediatrics Clinic during the period 1996-1972]

Pathological ASLO levels were observed in 1174 patients out of 48,074 admitted to the Turin University Paediatrics Clinic during a four-year period. An analysis is made of this series and the importance of routine determinations as a diagnostic and phophylactic aid is stressed.