Henoch–Schönlein Purpura in Two Pediatric Patients Presenting as Terminal Ileitis

Kanık, Ali; Köse, Engi̇n; Baran, Maşallah; Köse, Seda Şirin; Eliaçık, Kayı; Sayan, Ali; Helvacı, Mehmet Rami; Aksu, Nejat

doi:10.1007/s10620-014-3273-5

Cited by 12 publications

(20 citation statements)

References 14 publications

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“…Knowing that bowel perforation in children with HSP usually occurs due to intussusception and is in the small intestine, we report a rare case of HSP in a 42-year old female with rectal perforation who was admitted with abdominal pain and pus discharge during defecation. Terminal ileitis has been reported rarely in the literature (4,11,12). Crohn disease and PID were the other differential diagnosis in this patient but since, according to her history, about 9 months ago she divorced and did not have any subsequent sexual activity, PID was ruled out.…”

Section: Case Reportmentioning

confidence: 78%

Rectal perforation in a 42-year-old woman due to Henoch-Schönlein purpura: a case report

et al. 2017

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SUMMARYHenoch-Schönlein purpura (HSP) is caused by deposition of IgA-containing immune complexes within the blood vessels. HSP mostly occurs in children and is less common in adults. In addition to palpable purpura, arthritis or arthralgia, renal disease and abdominal pain, gastrointestinal symptoms occur in 50% of children. These can be caused by gastrointestinal hemorrhage, bowel ischemia and necrosis, intussusception, and bowel perforation. In adults, intussusception is less frequent than in children. We report a 42-year-old woman referred to our hospital with acute abdominal pain. After laboratory and radiologic examinations, laparatomy was performed which revealed rectal perforation due to HSP. HSP is a multisystem disorder. Abdominal pain in patients with HSP may herald a serious gastrointestinal problem also in adult patients. Key words:Henoch-Schönlein purpura; Bowel perforation; Abdominal pain; Rectal perforation. Reumatismo, 2017; 69 (3): 131-133 n INTRODUCTION H enoch-Schönlein purpura (HSP), also called IgA vasculitis, is caused by deposition of IgA-containing immune complexes within the blood vessels (1) and its characteristic finding is leukocytoclastic vasculitis. HSP mostly occurs in children between the ages of 3 and 15 years (2) and is less common in adults (3). The incidence of 3.4 to 14.3 per million was reported for HSP in adults (4). HSP manifestations in children include palpable purpura, arthritis or arthralgia, renal disease and abdominal pain (5). Gastrointestinal symptoms like nausea, vomiting, abdominal pain, and transient paralytic ileus occur in 50% of the children and the findings are: gastrointestinal hemorrhage; bowel ischemia and necrosis; intussusception, and bowel perforation (6). In adults, in addition to the above-mentioned manifestations, there are two main differences: intussusception is rare and the risk of renal disease is increased (7). The diagnosis of HSP is usually based on clinical manifestations, especially palpable purpura in the lower extremities and a biopsy of the involved organ (e.g., skin or kidney) in those who have unusual presentations. There is no specific diagnostic laboratory test (8). Imaging is commonly performed on patients with abdominal pain. Abdominal radiography may show dilatation of the bowel loops; it may demonstrate peritoneal fluid, hematomas, intussusception and an increased bowel wall thickness (9). We report a rare case of rectal perforation due to HSP in a 42-year-old woman. n CASE REPORTA 42-year-old woman with chief complaint of abdominal pain, was referred to Rasool-e-Akram hospital in February 2015. Her pain had started gradually a week before in the hypogastric region re- We report a 42-year-old woman referred to our hospital with acute abdominal pain. After laboratory and radio logic examinations, laparatomy was performed which revealed rectal perforation due to HSP. risk of renal disease is increased (7). The u s e blood vessels. HSP mostly occurs in children and is less common in adults. In addition to palpable purpura, u s e...

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Section: Case Reportmentioning

confidence: 78%

Rectal perforation in a 42-year-old woman due to Henoch-Schönlein purpura: a case report

et al. 2017

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“…Terminal ileitis has rarely been reported in 9 patients with HSP. 5 , 15 , 16 This is the second report of a patient with terminal ileitis who presented with acute appendicitis induced by HSP. The first case was reported by Yantis 17 in 1973, which illustrated a patient presented with acute appendicitis and Crohn disease.…”

Section: Discussionmentioning

confidence: 91%

“…HSP is usually diagnosed based on an atypical presentation; however, when atypical presentations are not evident, noninvasive diagnostic methods are needed to establish the diagnosis of HSP. 5 β2GPI facilitates the diagnosis of HSP, 11 and visfatin is abnormally elevated in patients with HSP. 12 …”

Section: Discussionmentioning

confidence: 99%

“…Abdominal pain precedes the rash in 12% to 19% of patients. 5 We present an unusual and rare case, in which a patient was diagnosed with acute appendicitis preoperatively, terminal ileitis was diagnosed intraoperatively, and when the rash occurred postoperatively, the diagnosis was revised to HSP.…”

Section: Introductionmentioning

confidence: 99%

“… 1 HSP is common in children between 2 and 10 years of age, and 90% of affected individuals are <10 years of age. 4 , 5 HSP occurs most often in the winter and spring. The incidence of HSP in adults is 3.4 to 14.3 per million; however, because HSP is self-limited, the actual incidence may be underreported.…”

Section: Introductionmentioning

confidence: 99%

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Terminal Ileitis Induced by Henoch–Schonlein Purpura That Presented as Acute Appendicitis

Tian

Li³

et al. 2015

Medicine

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Henoch–Schonlein purpura (HSP) is a self-limited autoimmune disease, the cause of which is not clear. Gastrointestinal involvement is often the main symptom of HSP. We report an unusual and rare case in a patient who was diagnosed with HSP. This is the second report of terminal ileitis induced by HSP that presented as acute appendicitis.We report a 21-year-old man who presented with right lower abdominal pain, and was diagnosed with acute appendicitis. Terminal ileitis was diagnosed intraoperatively, and when a rash occurred postoperatively, the final diagnosis was HSP.When the rash occurred, HSP was diagnosed and methylprednisolone was administered for 5 days.The diagnosis of HSP is difficult to establish, especially when the purpura occurs after gastrointestinal involvement; thus, abdominal pain should not be ignored and HSP should be considered.

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Evaluation of acute terminal ileitis in children before and during the COVID‐19 pandemic

Koyuncu,

Bükülmez,

Güngör

et al. 2023

J. pediatr. gastroenterol. nutr.

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ObjectivesThe aim of this study was to examine the clinical features of acute terminal ileitis in children and evaluate its rate before and during the COVID‐19 pandemic.MethodsThis retrospective study was performed in our pediatric emergency department between 2018 and 2022. The records of 5363 patients who required abdominal imaging due to acute abdomen were analyzed, and 143 patients with terminal ileitis were included. The rate and etiological causes were compared during and before the COVID‐19 pandemic.ResultsThe rate of acute terminal ileitis has increased over the years. The fastest increase was in 2021, when the COVID‐19 pandemic was experienced. While 59 (41.2%) patients showed acute nonspecific ileitis, the most common etiologic cause that could be identified was acute gastroenteritis. It was determined that multisystem inflammatory syndrome in children was among the causes of ileitis after the COVID‐19 pandemic and was one of the top three causes.ConclusionsAcute terminal ileitis, which has many etiologies, is one of the rare radiological findings in acute abdominal pain. Examination and laboratory findings are not specific. Guidelines are needed for the investigation of the underlying etiology of acute terminal ileitis in children. The incidence of acute terminal ileitis is increasing, and the increase has been found to be faster after the COVID‐19 pandemic.

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Henoch–Schönlein Purpura in Two Pediatric Patients Presenting as Terminal Ileitis

Cited by 12 publications

References 14 publications

Rectal perforation in a 42-year-old woman due to Henoch-Schönlein purpura: a case report

Rectal perforation in a 42-year-old woman due to Henoch-Schönlein purpura: a case report

Terminal Ileitis Induced by Henoch–Schonlein Purpura That Presented as Acute Appendicitis

Evaluation of acute terminal ileitis in children before and during the COVID‐19 pandemic

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