We describe a case of an adolescent male with Henoch-Schonlein purpura (HSP), presenting with cutaneous and gastrointestinal manifestations. Endoscopy revealed diffuse ulcerations in the stomach, duodenum, and right colon. Biopsies revealed a leukocytoclastic vasculitis in the skin and gastrointestinal tract. Steroid therapy led to complete resolution of the symptoms. HSP is the most common childhood vasculitis, and is characterized by the classic tetrad of nonthrombocytopenic palpable purpura, arthritis or arthralgias, gastrointestinal and renal involvement. It is a systemic disease where antigen-antibody (IgA) complexes activate the alternate complement pathway, resulting in inflammation and small vessel vasculitis. Mild disease resolves spontaneously, and symptomatic treatment alone is sufficient. Systemic steroids are recommended for moderate to severe HSP. The prognosis depends upon the extent of renal involvement, which requires close followup. Early recognition of multiorgan involvement, especially outside of the typical age group, as in our adolescent patient, and appropriate intervention can mitigate the disease and limit organ damage.

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Chronic hepatitis B virus (HBV) infection is a significant, worldwide burden due to it's high prevalence, and risk of complications, including cirrhosis and hepatocellular carcinoma (HCC). Current literature suggests that African patients with chronic hepatitis B are at higher risk for hepatocellular carcinoma. The exact mechanism for the explanation for this observation is contentious and may be due to higher rates of chronicity, and/or exposure to hepatotoxins including aflatoxin. We sought to report the clinical characteristics of African born immigrants with chronic hepatitis B referred to a liver clinic in New York City. A total of 111 patients were enrolled. 19 patients (17%) had cirrhosis, and 14 patients (13%) had HCC at initial presentation. During the course of follow up, 13 patients (12%) died of complications of HBV, all of them related to HCC. Our case series revealed that a significant proportion of these patients manifested advanced complications of HBV such as cirrhosis or HCC.

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