Gastrointestinal bleeding in adult patients with Henoch–Schönlein purpura

Nam, Eon Jeong; Kim, Gun Woo; Kang, Jieun; Im, Churl Hyun; Cho, Chang-Min; Jeong, Ji Yun; Park, Ji Young; Jang, Yeon Jin; Kang, Young Mo

doi:10.1055/s-0034-1377757

Cited by 26 publications

(23 citation statements)

References 7 publications

(9 reference statements)

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“…Almost all the patients had jejunum involved except one did not pass through pylorus. It was different from the report from Eon Jeong Nam et al [2]. In their report with a series of adult HSP patients, the second part and the terminal ileum were the most frequently involved parts of HSP patients, and colon was frequently involved as well.…”

Section: Discussioncontrasting

confidence: 73%

“…Among the patients with GI symptoms, there is a rare portion of patients without skin manifestations, which need endoscopy evaluation for diagnosis and differential diagnosis. HSP most affects the descending of the duodenum in adult patients, and the typical indication of endoscopy of HSP are erythema, petechia, erosion and ulceration [1,2]. Although esophagogastroduodenoscopy (EGD) is useful in the diagnosis of majority HSP patients with GI tract affected, there is still a portion of patients who could not be diagnosed.…”

Section: Introductionmentioning

confidence: 99%

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The characteristics of video capsule endoscopy in pediatric Henoch–Schönlein purpura with gastrointestinal symptoms

Fang

Peng

Zhao

et al. 2020

Preprint

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Background Henoch–Schönlein purpura (HSP) is a systemic small-vessel vasculitis that commonly affects gastrointestinal tract. The video capsule endoscopy (VCE) characteristics of pediatric HSP patients were rarely investigated. Methods Patients diagnosed with HSP by VCE examination at our hospital from February 2010 to January 2019 are analyzed. The clinical features, laboratory findings, and the characteristics of VCE findings are studied. Results There are 30 patients enrolled in this investigation from February 2010 to January 2020. The mean age of these patients is 96.9±35.8 months, and the most frequent finding of VCE is mucosal erosion, which account for 69 % of the patients, and followed by mucosal erythema or petechia accounted for 79.3 % of the patients. Regarding to the disease location detected by endoscopy, jejunum is the most common involved part of the gastrointestinal tract in pediatric HSP patients. All the patients had jejunum involved except in one patient the VCE did not pass through the pylorus. One third of the patients involved the descent part of duodenum. No side effects are observed in this study. Conclusions VCE is safe and effective in the diagnosis of gastrointestinal involved HSP patients with or without typical skin purpura. Jejunum is the most common involve location in gastrointestinal.

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Section: Discussioncontrasting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

The characteristics of video capsule endoscopy in pediatric Henoch–Schönlein purpura with gastrointestinal symptoms

Fang

Peng

Zhao

et al. 2020

Preprint

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“…13,14,16 Additionally, endoscopic features of GI lesions and histopathological findings of renal biopsies have also been studied; however, these modalities can cause serious complications and may be contraindicated in certain cases. 4,17 Therefore, to gain more prognostic information, we examined the utility of a noninvasive and easily obtainable cost-effective laboratory parameter. To our knowledge, this is the first biopsyproven case-control study to investigate the predictive value of NLR for systemic involvement in adult IgAV patients.…”

Section: Discussionmentioning

confidence: 99%

Neutrophil‐to‐lymphocyte ratio: a biomarker for predicting systemic involvement in adult IgA vasculitis patients

Nagy

Kemény

Bata‐Csörgő

2017

Acad Dermatol Venereol

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Background IgA vasculitis (IgAV) is a small‐vessel leucocytoclastic cutaneous vasculitis, often associated with kidney and gastrointestinal (GI) manifestations. Although predictive factors for systemic involvement have been extensively studied in children, there is paucity in the literature regarding adult patients. Neutrophil‐to‐lymphocyte ratio (NLR) is an inflammatory marker, used to assess systemic inflammation in various diseases. Objective We sought to evaluate whether NLR can be used for predicting renal and GI involvement in adult IgA vasculitis patients. Methods This was a retrospective review of adult patients who were diagnosed with IgAV at our institution between 2004 and 2016. Results A total of 40 patients met our inclusion criteria. Half of the enrolled patients had clinical symptoms suggestive of systemic involvement, of which 6 (15%) had only renal, 3 (7.5%) had only GI and 11 (27.5%) had both renal and GI involvement. Pretreatment NLR was significantly associated with renal and/or GI manifestations of the disease (P < 0.001). The optimal cut‐off value of NLR, for predicting systemic involvement was 3.34, with a specificity of 95% and a sensitivity of 85%. In addition, pretreatment NLR was also found to be significantly correlated with the severity of the systemic manifestations of IgAV (P = 0.022). Conclusion This study suggests that NLR is a potential indicator for prognosticating systemic involvement in adult IgAV.

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“…With microscopic hematuria being the most common renal manifestation in children, adults show a higher rate of gross hematuria with nephritic and nephrotic features [3,5]. Gastrointestinal manifestations are seen in about half of all HSP patients and can range from the commonly seen abdominal pain, nausea, vomiting, to rarely more severe involvement including gastrointestinal hemorrhage, bowel ischemia and perforation [6-7]. The gastrointestinal manifestations are seen with equal frequency in both children and adults, but the severe involvement is much less frequent in adults [3-4].…”

Section: Discussionmentioning

confidence: 99%

Henoch-Schönlein Purpura Presenting as Severe Gastrointestinal and Renal Involvement with Mixed Outcomes in an Adult Patient

Raj

Ramakrishnan

Vollmar

et al. 2017

Cureus

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Henoch-Schönlein purpura (HSP) is typically seen as a self-limiting disease in children, but can present more severely in adults, especially when there is renal involvement. Management of HSP in adults also remains a controversial topic with very few studies evaluating available therapies. In this case, HSP presenting as a combination of severe gastrointestinal involvement and a rapid decline in renal function in an adult patient directed our therapy.The patient was a 48-year-old Caucasian male with no known past medical history, who presented with a combination of purpuric rash over the lower extremities, severe abdominal pain with upper gastrointestinal bleeding and a rapidly increasing serum creatinine, with hematuria. He initially underwent a skin biopsy, along with investigation for other possible causes, including autoimmune and infectious etiologies, which were negative. He was started on therapy for presumed HSP with intravenous methylprednisolone. The skin biopsy, however, was not conclusive, and the patient had no improvement in his clinical status. He then underwent a kidney biopsy that was consistent with HSP nephritis (immunoglobulin A (IgA) predominant glomerulonephritis with crescents), and esophagogastroduodenoscopy (EGD) that showed mucosal inflammation, ulcerations, and stigmata of bleeding—findings that were consistent with ischemia. Cyclophosphamide was added to the regimen at this time. However, he had worsening abdominal pain, continued gastrointestinal bleeding, now with hematochezia, and also worsening renal function that required dialysis. Plasmapheresis was then initiated on days alternating with dialysis. This resulted in the improvement of his gastrointestinal symptoms, but no recovery was seen of his renal function, and the patient required outpatient dialysis.This case report exhibits the unique presentation of severe gastrointestinal (GI) manifestations and rapid progression to renal failure in an adult patient with partial resolution of his severe manifestation after therapy was escalated as above. There was no established protocol that guided this therapy, which reflects the need for more studies on adult HSP.

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Gastrointestinal bleeding in adult patients with Henoch–Schönlein purpura

Cited by 26 publications

References 7 publications

The characteristics of video capsule endoscopy in pediatric Henoch–Schönlein purpura with gastrointestinal symptoms

The characteristics of video capsule endoscopy in pediatric Henoch–Schönlein purpura with gastrointestinal symptoms

Neutrophil‐to‐lymphocyte ratio: a biomarker for predicting systemic involvement in adult IgA vasculitis patients

Henoch-Schönlein Purpura Presenting as Severe Gastrointestinal and Renal Involvement with Mixed Outcomes in an Adult Patient

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