Dapsone therapy for Henoch-Schonlein purpura: a case series

Abstract

We would like to draw attention to a useful radiological sign indicating that a percutaneous central venous catheter may be in the ascending lumbar vein. In our neonatal unit there have been two confirmed cases where the ascending lumbar vein had inadvertently been cannulated. In both these cases a loop in the line had been noted in the region of the ileo-femoral vein (see figs 1 and 2). This ''looping'' or bend in the line is also seen in the picture recently published by De, 5 and in other papers. 1-3 That this complication occurs almost exclusively on the left 2 has been attributed to the unique anatomy of the left ileo-femoral vein compared to the right. 1 We believe that the local anatomy of the left ileo-femoral vein may also explain why the line loops when inadvertently entering the left ascending lumbar vein (fig 3). One can appreciate that, when the ascending lumbar vein is seen on the lateral 1 and lateral-oblique view, 4 and compared with the anterior posterior view, the vein can be seen to descend into the pelvis and then enter the ascending lumbar vein at an angle. On an x ray the line will then project a loop or bend. Another factor that may contribute to the appearance of the loop or bend is that it is probably difficult to advance the line up the narrow ascending lumbar vein, and therefore when trying to thread the line to its calculated length the line will ''buckle'' at this point. Any loop or bend of a contrast filled line in the left ileo-femoral region should be regarded as a sign that the line has entered the ascending lumbar vein and pull the line back because the lumbar venous plexus will not always be visualised with contrast. There are serious complications of an unrecognised malpositioned long line. 2 We feel that awareness of this radiological sign would facilitate early recognition and would prevent serious morbidity.

Gastrointestinal Manifestations of Henoch-Schonlein Purpura

“…Intravenous immunoglobulin therapy proved to be effective in a steroid-resistant individual and in one who suffered from several relapses when the corticosteroids were tapered [132,133]. Dapsone (diaminodiphenylsulfone) is a bacteriostatic sulphonamide with anti-inflammatory properties [134] that appeared to be helpful in case studies and small series, although its main effects may be to control cutaneous vasculitis [135]. None of these therapies have been tested in randomized, placebocontrolled trials.…”

The Importance of Toxoplasma Gondii Infection in Diseases Presenting With Headaches. Headaches and Aseptic Meningitis May Be Manifestations of the Jarisch-Herxheimer Reaction

“…There was an imbalance in the T H 1/T H 2 ratio with decreased T H 1 type function in HSP children (Sun et al, 2006;Yang, Li, Zu, Wang, & Li, 2006). Dapsone (diaminodiphenylsulfone), an antileprotic drug, was effective in some patients with HSP, especially on the skin rush (Iqbal & Evans, 2005;Shin, Lee, & Chung, 2006). It was believed that this resulted from its antioxidant scavenger properties that might suppress generation of toxic free radicals in neutrophils, and synthesis of IgG and IgA antibodies (Iqbal & Evans, 2005;Shin, Lee, & Chung, 2006).…”

Dapsone treatment is efficient against persistent cutaneous and gastrointestinal symptoms in children with Henoch-Schönlein purpura

“…Prognosis of HSP clearly depends on the presence of renal involvement and dapsone was shown to be ineffective in the control of HSP nephritis 6,7 . Nevertheless, its rapid effectivity against persistent, predominantly cutaneous, manifestations of HSP was confirmed both in previous studies and by our data.…”