Fatal Henoch-Schönlein Purpura in an Adult With Dieulafoy Lesions

Cristescu, Dan A.; Yuvienco, Candice; Schwartz, Stuart

doi:10.1097/rhu.0b013e318262e3f9

Cited by 3 publications

(3 citation statements)

References 11 publications

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“…IVIG and plasmapheresis may be beneficial in some cases of severe GI bleeding, but complications may occur with IVIG and plasmapheresis and these treatment modalities are very expensive. Additionally, some patients are non‐responsive to these treatment options . The common characteristics of the present patients were GI bleeding not responsive to conventional or high‐dose pulse MP.…”

Section: Discussionmentioning

confidence: 80%

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Management of intestinal bleeding with single‐dose cyclophosphamide in Henoch–Schönlein purpura

Uluca¹,

Ece

Şen³

et al. 2015

Pediatrics International

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In these case series, we report on six children (3 girls, 3 boys) aged 5-13 years with Henoch-Schönlein purpura (HSP) who developed severe gastrointestinal (GI) bleeding resistant to both 2 mg/kg or pulse (10-30 mg/kg) i.v. methylprednisolone. All patients responded to single-dose (500 mg/m(2) ) i.v. cyclophosphamide (CPA) and none of them developed new GI bleeding after CPA treatment. No patients required surgical intervention. Single high-dose CPA may be beneficial in HSP with severe GI involvement, in which bleeding is non-responsive to high-dose steroids.

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Section: Discussionmentioning

confidence: 80%

“…An adult case of HSP has been reported in which the patient did not respond to high‐dose MP or high‐dose CPA, but did partially respond to plasmapheresis . In another adult case, GI bleeding was stopped and the patient improved with high‐dose CPA while on high‐dose MP treatment …”

Section: Discussionmentioning

confidence: 99%

Management of intestinal bleeding with single‐dose cyclophosphamide in Henoch–Schönlein purpura

Uluca¹,

Ece

Şen³

et al. 2015

Pediatrics International

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“…There is at least one other case report of a patient with Henoch-Schonlein Purpura (HSP) treated with cyclophosphamide who died of an unexpected DL bleed. The authors of that case report postulated that a cyclophosphamide-induced pancytopenia increased the hemorrhagic diathesis of their patient [8]. This may have been a contributing factor in this case in which thrombocytopenia was present during the second episode of rectal bleeding.…”

Section: Discussionmentioning

confidence: 85%

Finding the Dieulafoy’s Lesion: A Case of Recurrent Rectal Bleeding in an Immunosuppressed Patient

Hudspath

Russell

Eum

et al. 2019

Case Reports in Gastrointestinal Medicine

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A Dieulafoy’s lesion (DL) is rare cause of acute gastrointestinal bleeding defined as a vascular abnormality of the submucosa. With a high prevalence for the stomach and upper gastrointestinal tract, it is rarely observed in the lower gastrointestinal tract. Its prevalence is rare accounting for less than 2% of all cases of acute gastrointestinal bleeding. The etiology of DL is unknown. Common comorbidities include cardiovascular disease, kidney disease, diabetes, alcohol abuse, liver disease, and chronic NSAID use. Few cases involving chronic steroid use and immunosuppressive treatment have been reported. The most common diagnostic and treatment modality is endoscopy with refractory cases treated with arterial embolization by angiography. We present a case involving a patient with significant comorbidities on chronic immunosuppression with a life-threatening, massive lower gastrointestinal bleed from a DL in the rectum.

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Rectal Dieulafoy’s lesion: a comprehensive review of patient characteristics, presentation patterns, diagnosis, management, and clinical outcomes

Inayat¹,

Hussain²,

Yahya³

et al. 2022

Transl Gastroenterol Hepatol

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Dieulafoy's lesion is an abnormally large, tortuous, submucosal vessel that erodes the overlying mucosa, without primary ulceration or erosion. Although these lesions predominantly involve the stomach and upper small intestine, they are being detected with increasing frequency in the rectum. We conducted a systematic literature search of MEDLINE, Cochrane, Embase, and Scopus databases for adult rectal Dieulafoy's lesion. After careful review of the search results, a total of 101 cases were identified. The data on patient characteristics, clinical features, colonoscopy findings, diagnosis, treatment, and clinical outcomes were collected and analyzed. The mean age of presentation was 66±17 years (range, 18-94 years), with 54% of cases reported in males. Clinical presentation was dominated by acute lower gastrointestinal bleeding in the form of bright-red blood per rectum 47% and hematochezia 36%, whereas 16% of patients were admitted with symptoms related to other medical conditions. Major underlying disorders were hypertension 29%, diabetes mellitus 21%, and chronic kidney disease 16%. The average number of colonoscopies required for the diagnosis of rectal Dieulafoy's lesion was 1.5±0.7. In regard to treatment, endoscopic therapy was applied in 80%, direct surgical suturing in 12%, angiographic embolization in 4%, and endoscopic therapy followed by surgical ligation was performed in 4% of patients. The endoscopic treatment was a feasible choice for rectal disease, with a primary hemostasis rate of 88%. Although the overall mortality rate was 6%, the causes of death were unrelated to this entity. This review illustrates that patients with rectal Dieulafoy's lesion can have a favorable clinical outcome. Prompt diagnosis and appropriate management are of paramount importance to prevent serious hemodynamic complications. The best therapeutic modality remains to be determined but the data presented here support the use of mechanical endoscopic methods as safe and effective.

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Fatal Henoch-Schönlein Purpura in an Adult With Dieulafoy Lesions

Cited by 3 publications

References 11 publications

Management of intestinal bleeding with single‐dose cyclophosphamide in Henoch–Schönlein purpura

Management of intestinal bleeding with single‐dose cyclophosphamide in Henoch–Schönlein purpura

Finding the Dieulafoy’s Lesion: A Case of Recurrent Rectal Bleeding in an Immunosuppressed Patient

Rectal Dieulafoy’s lesion: a comprehensive review of patient characteristics, presentation patterns, diagnosis, management, and clinical outcomes

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