1
|
Öner N, Çelikel E, Tekin ZE, Güngörer V, Kurt T, Tekgöz PN, Sezer M, Karagöl C, Coşkun S, Kaplan MM, Polat MC, Acar BÇ. Intravenous immunoglobulin therapy in immunoglobulin A vasculitis with gastrointestinal tract involvement. Clin Exp Med 2023; 23:1773-1782. [PMID: 36441440 DOI: 10.1007/s10238-022-00950-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate the outcomes of patients who received intravenous immunoglobulin (IVIG) for immunoglobulin A vasculitis (IgAV) with gastrointestinal (GI) tract involvement, and to determine the differences between the groups that responded to IVIG and those that did not. METHODS This retrospective study comprised 152 patients with IgAV between 2018 and 2022. Sixty-five patients (43%) had GI tract involvement. Patients with IgAV-GI involvement who had been treated with IVIG were evaluated. Patients were classified with IgAV according to the 2008 Ankara-EULAR/PRINTO/PRES. Their demographics, presentation, and management are reported. RESULTS Twelve (7 boys/5 girls) of these patients were treated with IVIG. The median age was 90.1 (31-177) months. The mean follow-up period was 30.6 ± 9.9 months. All patients had skin involvement, joint involvement (arthralgia or arthritis), and abdominal pain. All 12 patients were given steroids (30 mg/kg/day pulse methylprednisolone for 3-7 days, followed by 2 mg/kg/day steroids) before IVIG. Nine patients received cyclophosphamide treatment (four before IVIG and five after IVIG). Complete remission was achieved in 5 of the patients with IVIG. Four patients were diagnosed with IgAV concomitant familial Mediterranean fever, and colchicine treatment was initiated. CONCLUSIONS IVIG may be used in steroids and/or immunosuppressive drug resistant IgAV. It can be considered as a treatment option, especially in patients with multi-organ/system involvement, comorbid inflammatory diseases such as familial Mediterranean fever, and in patients with IgAV-GI tract involvement resistant to standard treatment in the advanced pediatric age group.
Collapse
Affiliation(s)
- Nimet Öner
- Division of Pediatric Rheumatology, Department of Pediatrics, Ankara City Hospital, University of Health Sciences, 06800, Bilkent, Cankaya/Ankara, Turkey.
| | - Elif Çelikel
- Division of Pediatric Rheumatology, Department of Pediatrics, Ankara City Hospital, University of Health Sciences, 06800, Bilkent, Cankaya/Ankara, Turkey
| | - Zahide Ekici Tekin
- Division of Pediatric Rheumatology, Department of Pediatrics, Ankara City Hospital, University of Health Sciences, 06800, Bilkent, Cankaya/Ankara, Turkey
| | - Vildan Güngörer
- Division of Pediatric Rheumatology, Department of Pediatrics, Ankara City Hospital, University of Health Sciences, 06800, Bilkent, Cankaya/Ankara, Turkey
| | - Tuba Kurt
- Division of Pediatric Rheumatology, Department of Pediatrics, Ankara City Hospital, University of Health Sciences, 06800, Bilkent, Cankaya/Ankara, Turkey
| | - Pakize Nilüfer Tekgöz
- Division of Pediatric Rheumatology, Department of Pediatrics, Ankara City Hospital, University of Health Sciences, 06800, Bilkent, Cankaya/Ankara, Turkey
| | - Müge Sezer
- Division of Pediatric Rheumatology, Department of Pediatrics, Ankara City Hospital, University of Health Sciences, 06800, Bilkent, Cankaya/Ankara, Turkey
| | - Cüneyt Karagöl
- Division of Pediatric Rheumatology, Department of Pediatrics, Ankara City Hospital, University of Health Sciences, 06800, Bilkent, Cankaya/Ankara, Turkey
| | - Serkan Coşkun
- Division of Pediatric Rheumatology, Department of Pediatrics, Ankara City Hospital, University of Health Sciences, 06800, Bilkent, Cankaya/Ankara, Turkey
| | - Melike Mehveş Kaplan
- Division of Pediatric Rheumatology, Department of Pediatrics, Ankara City Hospital, University of Health Sciences, 06800, Bilkent, Cankaya/Ankara, Turkey
| | - Merve Cansu Polat
- Division of Pediatric Rheumatology, Department of Pediatrics, Ankara City Hospital, University of Health Sciences, 06800, Bilkent, Cankaya/Ankara, Turkey
| | - Banu Çelikel Acar
- Division of Pediatric Rheumatology, Department of Pediatrics, Ankara City Hospital, University of Health Sciences, 06800, Bilkent, Cankaya/Ankara, Turkey
| |
Collapse
|
2
|
Abstract
Cutaneous vasculitis, inflammatory destruction of blood vessels, can present with a wide range of clinical and pathologic findings across a number of heterogeneous conditions. Although some vasculitides are present in both children and adults, some important differences exist in clinical presentation, etiology, management, and prognosis in childhood vasculitis versus adult vasculitis. Cutaneous vasculitis is rare in children, and most childhood vasculitides, of which Henoch-Schönlein purpura is the most common, histologically are small vessel leukocytoclastic vasculitis. In children, infectious etiologies are more common than in adults. Childhood cutaneous vasculitis is most often self-limited with a good prognosis, and treatment is mainly supportive. © 2017 Elsevier Inc. All rights reserved.
Collapse
Affiliation(s)
- Nikita Lakdawala
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI.
| | | |
Collapse
|
3
|
Bae CB, Lee JW, Kim HA, Jung JY, Kim HG, Lee MY, Ahn SJ, Park HL, Lee HJ, Kang E, Lee MJ, Kim SR, Suh CH. Initial Hematochezia and Kidney Involvement are Important Prognostic Factors of Adult Onset Henoch-Schönlein Purpura in Korea. JOURNAL OF RHEUMATIC DISEASES 2012. [DOI: 10.4078/jrd.2012.19.5.254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Chang-Bum Bae
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Jin-Woo Lee
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Hyoun-Ah Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Ju-Yang Jung
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Han Gyeol Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Mi Yeon Lee
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Seun Joo Ahn
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Hae-lin Park
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Hyo-Jin Lee
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Eunjung Kang
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Min-Jeong Lee
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Sei Rhan Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Chang-Hee Suh
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| |
Collapse
|
6
|
Chaudhary K, Shin JY, Saab G, Luger AM. Successful treatment of Henoch-Schonlein purpura nephritis with plasma exchange in an adult male. NDT Plus 2008; 1:303-6. [PMID: 25983918 PMCID: PMC4421291 DOI: 10.1093/ndtplus/sfn106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Accepted: 07/02/2008] [Indexed: 11/24/2022] Open
Abstract
Henoch-Schonlein purpura (HSP) frequently occurs in children under 15 years of age but is quite rare in adults. Most children who develop HSP nephritis completely recover from the illness, whereas up to 40% of adults have persistent hematuria and 10% develop chronic renal failure. Plasma exchange alone has been shown to be beneficial in children who have HSP nephritis. Adults have been treated using immunosuppressive drugs such as cyclophosphamide but effects are not certain. Here, we present a case of a 59-year-old white male who developed HSP nephritis while undergoing treatment with steroids. The patient developed acute renal failure with proteinuria and hematuria ∼2 weeks after being initially diagnosed with HSP by skin biopsy. Renal biopsy showed proliferative, exudative glomerulonephritis involving all 20 glomeruli; some with early crescent formation. Immunofluorescence staining showed 3+ IgA deposits in mesangium suggesting HSP-induced GN. The patient's serum creatinine rose to 2.5 mg/dl with ∼5 g of proteinuria by dipstick. Steroids were continued and the patient received plasma exchange treatments. Due to a very low leukocyte count, immunosuppressive agents were not given. Subsequently, renal function improved and the creatinine level came down to 1.3 mg/dl and proteinuria to <1 g/24 h. Since then, 1 year after this event, his serum creatinine has continued to stay at 1.2 mg/dl and he has trace proteinuria while taking a low-dose ACE inhibitor. This case illustrates the usefulness of plasma exchange in adult onset HSP nephritis, even without concomitant use of cytotoxic agents.
Collapse
Affiliation(s)
| | - Ji-Young Shin
- University of Missouri Health Center , Columbia , USA
| | | | - Alan M Luger
- University of Missouri Health Center , Columbia , USA
| |
Collapse
|
7
|
Rech J, Fuchs F, Kallert S, Hueber AJ, Requadt C, Manger B, Kalden JR, Amann K, Strauss R, Schulze-Koops H. Plasmapheresis therapy in an elderly patient with rapidly progressive Henoch-Schönlein purpura with disseminated organ involvement. Clin Rheumatol 2006; 26:112-4. [PMID: 16429242 DOI: 10.1007/s10067-005-0113-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2005] [Revised: 10/05/2005] [Accepted: 10/10/2005] [Indexed: 11/27/2022]
Abstract
Henoch-Schönlein purpura (HSP) frequently occurs in children below the age of 15 years and is rare with increasing age. Prognosis and therapy largely depend on the clinical presentation. The disease may be preceded by an upper respiratory tract infection, and drugs have also been implicated in the pathogenesis of the disease. Most children recover from the illness, whereas 40% of adults have persistent hematuria and 10% develop chronic renal failure. Recent studies strongly suggest that adults with HSP should be monitored for prolonged periods and treated aggressively. Here, we present a case of a patient with HSP who developed multiorgan failure requiring assistance in breathing and dialysis, and also sustained gastrointestinal bleeding despite aggressive immunosuppressive therapy. In analogy to published data in children with severe HSP, the patient was treated by plasma exchange in combination with low dose oral cyclophosphamide, while high dose steroids were reduced over time. The patient could be discharged 70 days after admission. One year after discharge, the patient is doing well without any signs of activity of HSP and completely unremarkable renal function. The maintenance daily dose of steroids is 7.5 mg.
Collapse
Affiliation(s)
- J Rech
- Department of Internal Medicine III, University of Erlangen-Nuremberg, 91054, Erlangen, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|