Analysis of children with Henoch–Schonlein purpura secondary to infection

Liu, Can; Luo, Lingli; Fu, Min; Li, Zhengqiu; Liu, Jianlong

doi:10.1007/s10067-021-06007-9

Cited by 6 publications

(6 citation statements)

References 43 publications

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“…IgAV/HSP was the most common subtype of vasculitis associated with COVID‐19. This finding is not surprising, given that IgAV/HSP is the most common primary systemic vasculitis of childhood (24) and has been strongly linked to triggers like infections (25,26). We compared the characteristics of COVID‐19–associated IgAV/HSP in our pediatric patients with those of our pre‐pandemic pediatric IgAV/HSP cohort of 159 patients (details in Table 2) (7).…”

Section: Discussionmentioning

confidence: 93%

The Characteristics of Patients With COVID‐19–Associated Pediatric Vasculitis: An International, Multicenter Study

Batu

Şener

Baykal

et al. 2023

Arthritis & Rheumatology

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Objective COVID‐19–associated pediatric vasculitis, other than Kawasaki disease (KD)–like vasculitis in multisystem inflammatory syndrome in children (MIS‐C), is very rare. This study sought to analyze the characteristics, treatment, and outcomes in patients with COVID‐19–associated pediatric vasculitis (excluding KD‐like vasculitis in MIS‐C). Methods The inclusion criteria were as follows: 1) age <18 years at vasculitis onset; 2) evidence of vasculitis; 3) evidence of SARS–CoV‐2 exposure; and 4) ≤3 months between SARS–CoV‐2 exposure and vasculitis onset. Patients with MIS‐C were excluded. The features of the subset of patients in our cohort who had COVID‐19–associated pediatric IgA vasculitis/Henoch Schönlein purpura (IgAV/HSP) were compared against a pre‐pandemic cohort of pediatric IgAV/HSP patients. Results Forty‐one patients (median age 8.3 years; male to female ratio 1.3) were included from 14 centers and 6 countries. The most frequent vasculitis subtype was IgAV/HSP (n = 30). The median duration between SARS–CoV‐2 exposure and vasculitis onset was 13 days. Involvement of the skin (92.7%) and of the gastrointestinal system (61%) were the most common manifestations of vasculitis. Most patients (68.3%) received glucocorticoids, and 14.6% also received additional immunosuppressive drugs. Remission was achieved in all patients. All of the patients with IgAV/HSP in our cohort had skin manifestations, while 18 (60%) had gastrointestinal involvement and 13 (43.3%) had renal involvement. When we compared the features of this subset of 30 patients to those of a pre‐pandemic pediatric IgAV/HSP cohort (n = 159), the clinical characteristics of fever and renal involvement were more common in our COVID‐19–associated pediatric IgAV/HSP cohort (fever, 30% versus 5%, respectively [ P < 0.001]; renal involvement, 43.3% versus 17.6%, respectively [ P = 0.002]). Recovery without treatment and complete recovery were each less frequent among our COVID‐19‐associated pediatric IgAV/HSP patients compared to the pre‐pandemic pediatric IgAV/HSP cohort (recovery without treatment, 10% versus 39%, respectively [ P = 0.002]; complete recovery, 86.7% versus 99.4%, respectively [ P = 0.002]). Conclusion This is the largest cohort of children with COVID‐19–associated vasculitis (excluding MIS‐C) studied to date. Our findings suggest that children with COVID‐19–associated IgAV/HSP experience a more severe disease course compared to pediatric IgAV/HSP patients before the pandemic.

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Section: Discussionmentioning

confidence: 93%

The Characteristics of Patients With COVID‐19–Associated Pediatric Vasculitis: An International, Multicenter Study

Batu

Şener

Baykal

et al. 2023

Arthritis & Rheumatology

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“…It is thought that many types of bacteria and viruses induce abnormal IgA autoimmune reactions and are therefore associated with its pathogenesis [1] . In fact, studies show a 28–73% infection rate in those with IgAV [10] . M. pneumoniae is a common cause of respiratory infection in children, which is also the age group with the highest incidence of IgAV [10] .…”

Section: Discussionmentioning

confidence: 99%

“…In fact, studies show a 28–73% infection rate in those with IgAV [10] . M. pneumoniae is a common cause of respiratory infection in children, which is also the age group with the highest incidence of IgAV [10] . Among the bacterial pathogens that cause atypical pneumonia, M. pneumoniae has most often been associated with small-vessel vasculitis, and especially IgAV [10] , [11] .…”

Section: Discussionmentioning

confidence: 99%

“…M. pneumoniae is a common cause of respiratory infection in children, which is also the age group with the highest incidence of IgAV [10] . Among the bacterial pathogens that cause atypical pneumonia, M. pneumoniae has most often been associated with small-vessel vasculitis, and especially IgAV [10] , [11] . To our knowledge, C. pneumoniae infection has been reported to be the trigger for IgAV in only one other case prior to this [12] .…”

Section: Discussionmentioning

confidence: 99%

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Immunoglobulin A vasculitis induced by atypical pneumonia infection with Chlamydophila pneumonia

Kang

Khalaf

Nelson

2022

IDCases

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“…HSP is an IgA-mediated vasculitis, and infection is the main cause of its development. [ 14 , 15 ] The continuous depletion of plasma IgA caused by HSP leads to massive proliferation of EBV, which can stimulate the body to produce more immune complexes, resulting in damage to the glomerular basement and filtration membranes or directly exerting viral cytopathic effects (immune complex injury or direct viral cytopathic effect is one of the potential mechanisms), thus further exacerbates the HSP condition. [ 16 ] EBV infection is a risk factor for secondary renal damage in HSP and one of the factors that make HSP difficult to treat EBV.…”

Section: Discussionmentioning

confidence: 99%

A chronic EBV infection causing persistent facial erythema multiforme and a retrospective literature review: A case report

Peng

Hui

2022

Medicine

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Rationale: Epstein-Barr virus (EBV) infection is associated with a variety of diseases and can involve multiple organs and systems, with complex and nonspecific clinical manifestations that are easily misdiagnosed. Chronic EBV infection with persistent erythema multiforme (EM) on the cheek as the main manifestation is very rare and has been reported rarely. Patient Concerns: This article reports a case of an adolescent female with chronic EBV infection who presented with chronic symmetrical erythema lesions on the face for 4 years, exacerbated with photophobia, lacrimation, Henoch-Schonlein purpura (HSP)-like rash, decline in granulocyte and erythrocyte lineages, hematuria, and proteinuria for 1 week. Diagnoses: The disease was initially misdiagnosed as systemic lupus erythematosus (SLE) and later confirmed as chronic EBV infection by skin biopsy. In the case, EBV infection not only caused chronic facial EM, but also induced acute HSP and purpura nephritis (hematuria and proteinuria type). Interventions: The child was treated with 1 week of glucocorticosteroids in adequate doses combined with acyclovir antiviral therapy and 3 sessions of hemoperfusion. After discharge, she took prednisone acetate (15 mg twice a day) orally for 1 month and then discontinued. Outcomes: She was discharged with her rash relieved and normal blood routine test and urine routine test. After 13 months of long-term follow-up, her facial erythema and hyperpigmentation became lighter, and there was no new rash on the whole body, and no abnormality in continuous monitoring of complete blood count and urine test. Lessons: This case suggests the need to be alert for chronic EBV infection in adolescent females with chronic facial EM rash and multiple organs and systems injury, in addition to connective tissue diseases such as SLE.

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Analysis of children with Henoch–Schonlein purpura secondary to infection

Cited by 6 publications

References 43 publications

The Characteristics of Patients With COVID‐19–Associated Pediatric Vasculitis: An International, Multicenter Study

The Characteristics of Patients With COVID‐19–Associated Pediatric Vasculitis: An International, Multicenter Study

Immunoglobulin A vasculitis induced by atypical pneumonia infection with Chlamydophila pneumonia

A chronic EBV infection causing persistent facial erythema multiforme and a retrospective literature review: A case report

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