Gastrointestinal involvement revealing Henoch Schonlein purpura in adults: Report of three cases and review of the literature

Hamzaoui, A.; Melki, W.; Harzallah, O.; Njim, Leïla; Klii, R.; Mahjoub, S.

doi:10.1186/1755-7682-4-31

Cited by 16 publications

(29 citation statements)

References 27 publications

(26 reference statements)

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“…HSP usually presents with a classic tetrad of skin purpura, poly‐arthralgia, abdominal pain, and renal disease. Gastrointestinal symptoms include periumbilical and colicky pain, abdominal pain, occult blood loss, colorectal bleeding, nausea, vomiting, diarrhea, constipation, and abdominal distension [4]. Rare findings include intestinal perforation, ischemic vasculitis, intussusception, pseudomembranous colitis, pancreatitis, acute acalculous cholecystitis, appendicitis, and bowel necrosis [4].…”

Section: Discussionmentioning

confidence: 99%

Ileal ulcers in a patient with Henoch‐Schönlein purpura

Shih

Liang

Lin

et al. 2015

Adv in Digestive Medicine

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Henoch-Schönlein purpura (HSP) is a systemic vasculitis characterized by a classic tetrad of nonthrombocytopenic palpable purpura, arthritis, gastrointestinal, and renal involvement. The most common gastrointestinal complaint is abdominal pain. The characteristic endoscopic findings are ulcers seen in the second portion of the duodenum. We present the case of a 45-year-old man suffering from abdominal pain. Erythematous purpura over bilateral lower extremities and soreness of the joints developed 3 days before abdominal pain. An abdominal computed tomography showed an edematous change of the intestinal wall and the distal part of the ileum. A retrograde single balloon enteroscopy revealed several discrete ulcers and hyperemic mucosa in the distal ileum. The middle, proximal, and terminal ileum and ileocecal valve to the rectum were not affected. Under the impression of HSP, nonsteroidal anti-inflammatory drugs and prednisolone were administered. We concluded that balloon-assisted enteroscopy is helpful for differential diagnosis of small bowel lesions in adult patients with HSP.

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Section: Discussionmentioning

confidence: 99%

Ileal ulcers in a patient with Henoch‐Schönlein purpura

Shih

Liang

Lin

et al. 2015

Adv in Digestive Medicine

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“…The aetiology of the disease is not clear; however, infections, vaccines and α-1-antitrypsin deficiency may lead to HSP 3. A relationship between HSP associated with gastrointestinal involvement in children and adults and Helicobacter pylori infection was identified 1 8. Rarely, malignancies such as non-small cell lung cancer and prostate cancer have been reported to cause HSP 1 3 9 10…”

Section: Discussionmentioning

confidence: 99%

“…The pain, defined as ‘Bowel angina’, typically develops after meals and may be accompanied by bloody diarrhoea 4. Other symptoms include nausea, vomiting, haematemesis, melena and abdominal distension 1 3. Vasculitis of the mesenteric circulation is the cause of the symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Sometimes symptoms may be severe enough to require laparotomy. Rarely, intestinal perforation, invagination, pancreatitis, pseudomembranous colitis, oesophageal ulcers, appendicitis and massive bowel necrosis may develop 1 3…”

Section: Discussionmentioning

confidence: 99%

“…Henoch-Schönlein purpura (HSP) is a leukocytoclastic vasculitis, primarily seen in children, with skin, joints, gastrointestinal tract and renal involvement 1 2. The incidence of HSP in adults varies between 3.4 and 14.3 per million populations 3.…”

Section: Introductionmentioning

confidence: 99%

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The first case of Henoch-Schönlein purpura associated with rosuvastatin: colonic involvement coexisting with small intestine

et al. 2014

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SUMMARYHenoch-Schönlein purpura (HSP) is a systemic vasculitis affecting small vessels. It is the most common systemic vasculitis in children, and is rare in adults. Serious gastrointestinal complications are more common in childhood. Infections and drugs are the most prominent factors in the aetiology. Wall thickening in segments of the small intestine is commonly seen in imaging studies in gastrointestinal system (GIS) involvement. Simultaneous involvement of small intestine and colon is rare. An HSP case involving small intestine and colon in an adult patient due to the use of rosuvastatin, an antihyperlipidaemic agent, is presented, and is first of its kind reported in the literature. BACKGROUND

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Clinical significance of fecal calprotectin for the early diagnosis of abdominal type of Henoch–Schonlein purpura in children

Gao

Sun

et al. 2017

Clin Rheumatol

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The objective of this study is to explore the value of fecal calprotectin (FC) for early screening of the abdominal type of Henoch-Schonlein purpura (AHSP) in children. The study cohort included 40 children with AHSP treated at Shengjing Hospital of China Medical University from November 2014 to November 2015, and 40 children hospitalized in the Division of Pediatric Orthopedics in the corresponding period were selected as a control group. Fresh fecal samples were collected in the acute phase of the first visit (FC1), 3 days after treatment (FC2), and 7 days after treatment (FC3) from the AHSP group and the control group. Calprotectin levels in the fecal samples were measured using an enzyme-linked immunosorbent assay. At the same time, gastrointestinal performance and the laboratory examination indicators white blood cell (WBC) count and C-reactive protein (CRP) level were recorded. The median levels of FC1 (3053 μg/g) and FC2 (2778.3 μg/g) were higher than in the control group (102.5 μg/g), with significant differences among the three groups (p < 0.001). FC levels gradually decreased in remission, and the level of FC3 on day 7 was close to that of the control samples (p > 0.05). When the optimal cut-off was 264.5 μg/g, the area under the receiver operating characteristic (ROC) curve of FC for diagnosis of AHSP was 0.961 with a corresponding sensitivity and specificity of 93.1 and 87.5%, respectively. The levels of FC in children with AHSP were positively correlated with WBC count (r = 0.688) and CRP value (r = 0.513). The area under the ROC curve of WBC count for screening AHSP was 0.785 when the optimal cut-off value was 11.1 × 10/L with a corresponding sensitivity and specificity of 81.5 and 62.5%, respectively. The area under the ROC curve of CRP was 0.963 when the optimal cut-off value was 5.72 mg/dL with a corresponding sensitivity and specificity of 88.9 and 100%, respectively. Comparisons of FC, WBC count, and CRP level as diagnostic indicators of AHSP showed that the sensitivity of FC was higher than that of the WBC count and CRP level, and its diagnostic value was better than that of the WBC count. The levels of FC began to increase in the early stages of AHSP, showing a decreasing tendency in remission and tending to be within a normal range after a week or so. For the early diagnosis of AHSP, FC with a cut-off level of 264.5 μg/g has good sensitivity and specificity. The sensitivity of FC is better than that of the traditional inflammation indicators CRP and WBC count, and its diagnostic performance is better than WBC count; FC can be suitable as a new marker for the early diagnosis of AHSP.

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Gastrointestinal involvement revealing Henoch Schonlein purpura in adults: Report of three cases and review of the literature

Abstract: The diagnosis of Henoch-Schönlein purpura (HSP) is difficult, especially when abdominal symptoms precede cutaneous lesions.We report three cases of adult HSP revealed by gastrointestinal (GI) involvement.

Cited by 16 publications

References 27 publications

Ileal ulcers in a patient with Henoch‐Schönlein purpura

Ileal ulcers in a patient with Henoch‐Schönlein purpura

The first case of Henoch-Schönlein purpura associated with rosuvastatin: colonic involvement coexisting with small intestine

Clinical significance of fecal calprotectin for the early diagnosis of abdominal type of Henoch–Schonlein purpura in children

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