Endoscope Images of Schönlein-Henoch Purpura

Abstract

Background/Aims: Schönlein-Henoch purpura (SHP) is a systemic condition characterized by purpura associated with leukocytoclastic vasculitis. SHP diagnosis is more difficult in infrequent cases where gastrointestinal (GI) symptoms precede purpura. This report examines 11 cases of SHP at our hospital with specific regard to the incidences and details of GI symptoms. Methods: The clinical manifestations and endoscopic findings were investigated for their utility in SHP diagnosis. Results: Among the 11 cases, 3 showed GI symptoms prior to other manifestations. In terms of GI symptoms, abdominal pain was reported in all 11 cases, diarrhea in 4 cases, and bloody stools in 3 cases. Endoscopic findings were seen in the stomach in 7/10 cases, in the small intestine including the duodenum in 10/11 cases, and in the large intestine in 6/10 cases. The frequency of ulcer formation was significantly higher in the small intestine (including the duodenum) than in the stomach. Multiple specific erythematosus lesions were observed in the stomach and large intestine. Conclusion: Familiarity with characteristic endoscopic findings and careful observation of all GI findings are essential for diagnosing SHP in cases in which GI tract symptoms precede cutaneous findings.

Risk Factors Associated with Renal Involvement in Childhood Henoch-Schönlein Purpura: A Meta-Analysis

“…A sensitive scoring system based on these risk factors at onset to predict HSPN may become a focus of research. For children with gastrointestinal tract symptoms at onset, early gastrointestinal endoscopy is a good tool for assisting diagnosis of HSP [51]. Children with more than one risk factor require more intervention than those who are without those risk factors.…”

Primary Follicular Lymphoma of the Duodenum with Erosions as Atypical Macroscopic Features

“…The differential diagnosis of erosions include other relatively infrequent etiologies, such as cytomegalovirus infection [8], vasculitis [9], amyloidosis [10], gastrinoma, and duodenal adenocarcinoma. On the other hand, whitish lesions in the duodenum may be caused by various etiologies, such as normal lymph follicles, intestinal lymphangiectasia, chronic non-specific duodenitis, and giardiasis [11].…”

The cause of abdominal purpura in children and the advances in pathogenesis

“…Endoscopy can reveal that abdominal purpura is caused by gastrointestinal mucosal damage occurring in the stomach and the second (descending) part of the duodenum and the terminal ileum [3,4] , with microscopic manifestations of diffuse mucosal congestion and edema, extensive erosion, ulcers, bleeding, and mucosal lesions similar to the skin purpura; the typical presentation is different degrees of purple-red mucosa rash, and mucosa lesions can be normal [5][6][7] . In children with abdominal hypersensitivity purpura children, gastrointestinal vascular inflammation is caused by increased vascular permeability, resulting in cell fluid extravasation, interstitial edema, intestinal wall thickening, swelling, peristalsis disorders, and gastrointestinal mucosal damage, resulting in symptoms of abdominal pain [3,8] .…”