Henoch-Schonlein purpura with ischaemic bowel

Henoch-Schonlein Purpura Presenting as Upper Gastrointestinal Bleed in an Adult Patient

Henoch-Schonlein purpura (HSP) is a multi-system autoimmune disease that is relatively common in pediatric patients. HSP usually manifests as palpable purpura, arthralgia, abdominal pain, and acute kidney injury. Here, we present a case of an adult male with hematemesis as the initial presenting symptom of HSP. A previously healthy, 18-year-old Caucasian male presented with a one-day history of hematemesis associated with abdominal pain and non-bloody diarrhea. He also reported bilateral knee and ankle arthralgias with a painless skin rash on both lower extremities. Physical exam was positive for palpable, purpuric, non-blanchable skin rash involving bilateral lower extremities. Notable labs on admission included a white cell count of 10.8 x 10⁹/L and C-reactive protein of 4.8 mg/L. Upper endoscopy showed non-bleeding erosive gastropathy and duodenal erosions. Skin biopsy of the left leg showed immunoglobulin A (IgA) deposition within the walls of the superficial dermal vessels. The patient was started on intravenous methylprednisolone 500 mg daily followed by a steroid taper. Due to incomplete clinical response to steroids, mycophenolate mofetil 1000 mg twice daily was added and maintained for three months. His symptoms improved significantly, and he no longer complained of abdominal pain or diarrhea. Gastrointestinal manifestations are common in HSP patients. However, the diagnosis will be challenging when these symptoms precede other classical manifestations of HSP. History and physical exam are key components in accurately diagnosing HSP; nevertheless, skin biopsy remains the gold standard to confirm the diagnosis.

Henoch-Schönlein purpura as a rare cause of an acute abdomen

A 52-year-old man presented with a purpuric rash affecting his legs and hypertension. He was diagnosed with Henoch-Schönlein purpura and discharged with non-steroidal anti-inflammatory drugs. Three weeks later, he presented again with loss of appetite and vomiting before developing abdominal pain with pyrexia of 38.5°C and rigors. On examination, he was hypotensive with a distended abdomen and a national early warning score of 6. Computed tomography revealed enteropathy of Henoch-Schönlein purpura. The patient deteriorated and went for an emergency laparotomy, where 30cm of ischaemic small bowel was resected.

Vasculitis in the intensive care unit

The systemic vasculitides are a diverse set of diseases linked by the presence of blood-vessel inflammation and are often associated with life-threatening or critical complications, including glomerulonephritis, diffuse alveolar haemorrhage, pulmonary arterial hypertension and airway compromise. The protean manifestations of the systemic vasculitides make them challenging to diagnose. Early recognition, however, is crucial to improving outcomes. This article serves as an introduction to these complex diseases, reviewing the manifestations of systemic vasculitis that may be encountered in an intensive care setting, and outlines an overall approach to their treatment.

Acute appendicitis in two children with Henoch-Schönlein purpura

In Henoch-Schönlein purpura (HSP), involvement of the ileum and ascending colon with vasculitis can mimic appendicitis and cause unnecessary appendicectomy. A 13-year-old boy presented with signs of HSP and abdominal pain. He was treated with prednisolone (2 mg/kg/day) for 10 days, but there was no improvement. At laparotomy he had acute suppurative appendicitis. A 12-year-old girl presented with HSP associated with abdominal pain and bloody diarrhoea and at laparotomy was also found to have suppurative appendicitis. Both patients had vasculitic areas in the ileum. In HSP, although suppurative appendicitis is rare, it should always be considered and appropriate investigations, including ultrasonography, undertaken.

Small bowel ischaemia and perforation as a complication of Henoch-Schönlein Purpura in a previously healthy adult

Henoch-Schönlein purpura is a small vessel vasculitis with multi-system manifestations that commonly affects children. We describe a case of new onset Henoch-Schönlein purpura in a previously healthy 42-year-old female who required an emergency laparotomy for small bowel perforation.

Gastrointestinal manifestations of Henoch-Schonlein purpura in children

Henoch-Schonlein purpura (HSP) is the most common systemic vasculitis in childhood. The etiology and pathogenesis of HSP are still not very clear. The diagnostic criteria for HSP include palpable purpura with at least one other manifestation-abdominal pain, IgA deposition, arthritis or arthralgia, or renal involvement. Bacterial and viral infections are the most common triggers for HSP involving the gastrointestinal (GI) tract. The clinical manifestations of HSP include purpura, colicky abdominal pain and bloody stools. Some HSP patients have severe complications. Ultrasound is usually the first choice because it permits prompt detection of the involved gut and complications. Endoscopy permits direct observation of the mucous and biopsy of affected areas to detect abnormal IgA deposition or leukocytoclastic vasculitis (LCV). There are two types of diseases that should be differentiated from HSP involving the GI: diseases demonstrating purpura and those demonstrating thickened bowel wall. The majority of children with HSP improve spontaneously, and few patients need medications. Surgical intervention is usually not recommended.