Henoch-Schöenlein syndrome in Qatar: the effects of steroid therapy and paucity of renal involvement

Abstract

This is a retrospective study of 40 patients admitted to Hamad General Hospital in the state of Qatar between January 1983 and December 1987 with the diagnosis of Henoch-Schöenlein syndrome. Of the 40 patients, 25 were boys and 15 were girls, with a ratio of 1.6:1. Ages ranged from 2 years 3 months to 13 years, with a mean of 6 years. There were six episodes of recurrence in four patients. There was a clustering of cases in late summer and early winter. About half of the patients had a history of preceding upper respiratory infection. All of them had the typical skin rash. The percentages of joint, gastro-intestinal and renal manifestations were 80%, 65% and 17.39%, respectively. One patient had penile swelling which has not been reported before. Steroid therapy seemed to enhance early resolution of abdominal pain but did not affect the course of the syndrome. Sixty-seven per cent of the patients were followed up for from 4 weeks to 5 years, with a mean of 8 months. Only one patient with renal involvement continued to have proteinuria with microscopic haematuria and hypertension. The rest were normal within about 2 months. The remarkably low incidence of renal involvement in our study may be related to local variations in causative factors. Henoch-Schöenlein syndrome is a milder disease in Qatar than in other countries.

Risk of long term renal impairment and duration of follow up recommended for Henoch-Schonlein purpura with normal or minimal urinary findings: a systematic review

“…Five reports came from Europe (two from Finland, 2 8 two from Spain, 9 28 and one from the UK 6 ), three from South East Asia (two from Taiwan, 10 29 one from Thailand 18 ), two from the USA, 30 31 one from India, 32 and one from the Middle East (Qatar 33 ). Three reports date from the 1980s, 2 6 10 five from the 1990s, [29][30][31][32][33] and four were published since 2000. 8 9 18 28 They include a total of 1133 children (number ranging from 40 to 270 children in individual studies), all from secondary care institutions, with a follow up period ranging from a minimum of 6 weeks to a maximum of 36 years (table 1).…”

Henoch Schonlein Purpura – A 5-Year Review and Proposed Pathway

“…Our data, together with other studies, demonstrates an overall low risk of HSP associated nephritis in an unselected cohort of patients presenting with features of HSP, 91% had a self-limiting disease course in our series. There have now been several cohorts describing this, together with the finding that patients with HSP who present with or develop proteinuria are at the greatest risk of renal complications [2], [3], [4], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18]. A stratified approach to monitoring which is robust enough to allow early identification of the high-risk patients balanced against the inconvenience to the family, resource implications and burden to healthcare providers of prolonged or costly follow up therefore seems appropriate.…”

Henoch-Schönlein purpura associated with Strongyloides stercoralis infection

“…The presented patient complained of abdominal pain in spite of early introduction of corticosteroids, and the complete withdrawal of symptoms was achieved only after treatment with mebendazole, indicating the significance of strongyloidiasis for the development of HSP in the presented case. Corticosteroids provide for quick resolution of symptoms in HSP patients [44][45][46] , however, patients with strongyloides infection receiving im-munosuppressive drugs, and especially corticosteroids, may develop severe hyperinfection or disseminated infection syndrome [47][48][49] . S. Stercoralis is a nematode leading a complex life cycle.…”