A rare cause of myocarditis resulting in acute heart failure in the setting of Henoch–Schönlein purpura

Michas, George; Grigoriou, Konstantinos; Syrigos, Dimitrios; Alexopoulos, Nikolaos; Evdoridis, Constantinos; Trikas, Athanasios

doi:10.1016/j.hjc.2017.05.002

Cited by 7 publications

(3 citation statements)

References 11 publications

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“…In 60 patients with cardiac damage, 9 patients relapsed more than two times because of persistent cutaneous purpura, hematuria or proteinuria; however, only one relapsed among 16 patients with liver dysfunction. Michas et al 22 reported an adolescent patient who presented with acute heart failure as a consequence of myocardial involvement in the context of HSP, and considered the pathogenesis of myocarditis might be attributed to infectious agents, systemic inflammation, drugs and autoimmune disorders, etc. To our knowledge, the studies on HSP-associated liver dysfunction were seldom reported.…”

Section: Discussionmentioning

confidence: 99%

Predisposing factors of childhood Henoch-Schönlein purpura in Anhui province, China

Wang

Liu

et al. 2019

Journal of Investigative Medicine

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Henoch-Schönlein purpura (HSP) is a common autoimmune vasculitis in childhood. The detailed pathogenesis of HSP is still unclear, whereas several types of predisposing factors have been proved to be the initial step. The objectives of present study were to analyze the distribution of predisposing factors, association of the predisposing factors with clinical manifestations and HSP relapse/recurrence. 1200 children with HSP were recruited between January 2015 and December 2017. We reviewed their laboratory tests and medical histories associated with HSP onset. The annual incidence of HSP was 8.13–9.17 per 100 000 in Anhui province. HSP occurred more commonly in spring and winter than in summer with an obvious west-to-east gradient. Cutaneous purpura was the most prevalent manifestation (100%), followed by arthritis/arthralgias (43.67%), abdominal pain (40.17%) and renal involvement (18.17%). On admission, series of potential infections were identified in 611 patients (50.92%). The histories of allergy, injury, surgery, vaccination and tick bite were declared by 231 patients (19.25%), 15 patients (1.25%), 12 patients (1.00%), 4 patients (0.33%) and 3 patients (0.25%), respectively. However, predisposing factors could not be identified in 521 children with HSP (43.42%) yet. 123 cases (10.25%) relapsed or recurred more than one time; the mean number was 2.92, and the mean interval was 11.4 weeks. The infection is the most frequent predisposing factor regardless of clinical phenotypes and relapse/recurrence, whereas the clinical manifestations exhibit an obvious heterogenicity according to different predisposing factors.

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Section: Discussionmentioning

confidence: 99%

Predisposing factors of childhood Henoch-Schönlein purpura in Anhui province, China

Wang

Liu

et al. 2019

Journal of Investigative Medicine

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“…Myocardial involvement may occur in the form of myocarditis, pericarditis, atrioventricular block, and myocardial infarction and may lead to life-threatening cardiovascular failure. Symptoms include chest pain, exercise dyspnoea, decreased exercise tolerance, and peripheral oedema [55]. Other, sporadic manifestations include diffuse vesicular bleeding and anterior uveitis.…”

Section: Rare Manifestationsmentioning

confidence: 99%

IgA vasculitis, formerly known as Henoch-Schönlein purpura – the most common vasculitis in children

Jaszczura¹,

Bryłka²,

Góra³

et al. 2018

polp

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Henoch-Schönlein purpura (HSP) is the most common systemic vasculitis in children. It belongs to the group of small-vessel vasculitis associated with immune complexes, and the proper term is IgA vasculitis (IgAV). In HSP in the wall of small vessels, deposits of immune complexes composed of IgA1 and C3 complement component are found. The incidence of HSP is estimated at 3-26.7/100,000 children per year. The changes most often affect the skin, lower limbs, digestive tract, and kidneys and are accompanied by arthralgia and arthritis. In this review article we pay attention to the pathogenesis, possible clinical manifestations, irregularities in laboratory tests, and proper management of patients with HSP. The treatment should depend on the clinical condition of the patient and is primarily symptomatic. Good knowledge of the differentiation of clinical symptoms allows for quick diagnosis and the qualification of patients for appropriate supervision.

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“…Indeed, kidney involvement in patients with HSP determines the prognosis [1,2]. Moreover, cardiac involvement is rare in Henoch-Schönlein purpura, and few case reports have been published in the literature [3][4][5][6][7][8][9][10][11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Myocarditis and intracardiac thrombus due to Henoch-Schönlein purpura: case report and literature review

et al. 2020

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Cardiac involvement is very rare in patients with Henoch-Schönlein purpura (HSP). In this case study, we present an 8-year-old girl presenting with HSP-induced myocarditis and thrombus in the right atrium and HSP nephritis. To date, 15 cases of HSPrelated cardiac involvement have been reported in the PubMed/MEDLINE, Scopus, and Google Scholar databases. These cases, together with our case, are included in this review. We excluded those patients with other rheumatologic diseases (acute rheumatic fever, acute post-streptococcal glomerulonephritis, Kawasaki disease) accompanied by HSP. Three were children and 13 were adults and all were male except our case. This review revealed tachyarrhythmia, chest pain, dyspnea, murmur, and heart failure as the major signs. Cardiac tests, electrocardiogram (ECG), and imaging methods (echocardiography in all patients, cardiac magnetic resonance imaging (MRI) in three, cardiac biopsy in one, and post-mortem necropsy in three) showed that the cardiac involvements were pericardial effusion, intra-atrial thrombus, myocarditis, coronary artery changes, myocardial ischemia, infarction and necrosis, subendocardial hemorrhage, and left ventricular dilatation. Kidney involvement was not observed in three patients. As the treatment, high-dose prednisolone and cyclophosphamide, oral corticosteroid, azathioprine, nadroparin calcium, ACE inhibitors, calcium antagonists, beta-blockers, and diuretics were used. Eleven patients (all three children and eight of the adults) had a complete cardiac recovery. Cardiac involvement in adults was more likely to be fatal. Death (three patients), ischemia, and infarct have been reported only in adults. We suggested that early and aggressive treatment can be life-saving. MRI examination is effective at identifying cardiac involvement.

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A rare cause of myocarditis resulting in acute heart failure in the setting of Henoch–Schönlein purpura

Cited by 7 publications

References 11 publications

Predisposing factors of childhood Henoch-Schönlein purpura in Anhui province, China

Predisposing factors of childhood Henoch-Schönlein purpura in Anhui province, China

IgA vasculitis, formerly known as Henoch-Schönlein purpura – the most common vasculitis in children

Myocarditis and intracardiac thrombus due to Henoch-Schönlein purpura: case report and literature review

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