Diagnosis and treatment of adult mixed-type Henoch-Schönlein purpura

Abstract

Aim of the studyThe purpose of this study was to investigate the clinical manifestations and outcomes of patients with adult mixed-type Henoch-Schönlein purpura (HSP) and imaging characteristics of the disease, and to evaluate the efficacy of combined therapy in treating symptoms of HSP.Material and methodsFrom January 2008 to October 2015, 23 patients with adult mixed-type HSP were enrolled. Abdominal contrast-enhanced computed tomography (CT) examination and small intestinal enteroscopy were performed for all the patients. For patients with positive urine protein, ultrasonic guided renal needle biopsy with 18G biopsy needle was performed; immunofluorescence and pathologic examinations were performed. Combined therapy with antihistamine drugs, gastric acid suppressants and glucocorticoids was used to relieve abdominal pain, gastrointestinal tract bleeding and urine protein.ResultsThe typical skin manifestation of HSP is distributed purpura in dependent areas. Abdominal contrast-enhanced CT examination exhibited the intestinal canal wall thickening and edema. Small intestinal endoscopy showed diffused hyperemia, dropsy, and erosion. All the patients with positive urine protein showed significantly higher IgA levels. With the use of combined therapy, abdominal pain and gastrointestinal tract bleeding disappeared, and urine protein decreased gradually.ConclusionsHigher IgA levels with multiorgan involvement (gastrointestinal, kidney and skin) should make one consider the diagnosis. The combined examination of abdominal contrast-enhanced CT, small intestinal endoscopy and renal needle biopsy is a valuable method for the early diagnosis of adult mixed-type HSP.

Increased circulating innate lymphoid cell (ILC)1 and decreased circulating ILC3 are involved in the pathogenesis of Henoch-Schonlein purpura

“…Purpura, was the most typical clinical manifestation of the enrolled HSP patients, whereas there were other representative manifestations as well. According to their clinical manifestations, the patients of HSP were divided into five subgroups: purpura group (patients presenting only with typical skin Purpura, refer to the domestic and foreign classification criteria [ 34 ]), arthritis group (patients with skin Purpura and acute onset arthralgia or arthritis), abdominal group (patients with skin Purpura and acute onset diffuse abdominal colicky pain), renal group (patients with skin purpura and nephritis symptoms, such as hematuria or proteinuria, or IgA deposits in the kidney indicated by renal biopsy), and mixed symptoms (possessing more than two symptoms as stated above). Compared with the controls, the ratios of ILCs/lymphocytes were higher in patients in the arthritis and mixed groups ( P = 0.014 and P = 0.039 respectively), and the ILCs/PBMC ratios were higher in the same two groups ( P = 0.010 and P = 0.034).…”

Drug-Induced IgA Vasculitis in an Adult

“…Some clinicians recommend early diagnosis with a contrast-enhanced CT scan of the abdomen, small intestinal endoscopy, and a renal needle biopsy for earlier diagnosis, as well as a combination of antihistamines, gastric acid suppressants, and glucocorticoids to reduce gastrointestinal pain, hyperemia, and proteinuria [ 7 ].…”

Clinical application of compound Glycyrrhizin tablets in the treatment of patients with Simplex Henoch-Schonlein Purpura and its effect on immune function

“…All patients were included due to the first attack of this disease, and met the relevant diagnostic criteria of HSP. 7 Of the enrolled 80 cases, there were 43 males and 37 females, with an average age of 15.3±1.2 years old (5~36 years old). The average time from onset to the first outpatient visit was 5.7±1.5d days (3~10 d).…”