Masked severe stenosing ureteritis: a rare complication of Henoch-Schönlein purpura

Abstract

Henoch-Schönlein purpura (HSP)-associated stenosing ureteritis represents a rare complication of the disease, typically presenting with severe manifestations. This article reports on a 3.5-year-old boy with HSP and severe nephritis who developed a unilateral stenosing ureteritis with atypical manifestations, resulting in a nonfunctional kidney and consequent nephrectomy. The urinary tract ultrasound was normal in the first week of illness, and the diagnosis was made during follow-up 8 months after onset. The predominance of nephritic manifestations may have masked any signs of ureteritis, leading to the delay in diagnosis. To clarify the clinical spectrum of this complication, an extensive review of the literature was performed. We emphasize the necessity of repeated urinary tract ultrasound both early and later in the course of HSP, especially in cases with renal involvement, so that an early diagnosis of this complication can prevent a potentially serious renal outcome.

Ureteral or vesical involvement in Henoch–Schönlein syndrome: a systematic review of the literature

“…The long-term prognosis of Henoch-Schönlein syndrome is nearly totally attributable to kidney disease [1]. The present review complements the results of a preliminary review of the literature published 5 years ago [26]. It confirms that ureteral or vesical involvement, whose occurrence has never been analyzed quantitatively, is very rare, but, if present, is associated with substantial morbidity.…”

Urological Manifestations of Henoch-Schonlein Purpura: A Review

“…Obstruction of the ureter and ureteritis may occur as a result of HSP [17]. Therefore, it is important to perform ultrasounds routinely throughout the course of HSP to assess for possible ureteric complications [18]. Several cases have been reported in which patients undergoing treatment for prostate or bladder cancer develop HSP.…”

“…For example, Corbett et al [17] reported a 7-year-old African American boy with HSP who experienced bilateral sclerosing ureteritis, developing 4 weeks after the onset of HSP. Siomou et al [18] reported a 3-year-old boy diagnosed with unilateral stenosing ureteritis 8 weeks after the onset of HSP. In some cases, as in the case described by Siomou et al [18], ureteritis may be accompanied by nephritis, which may conceal underlying symptoms of ureteritis.…”

“…Siomou et al [18] reported a 3-year-old boy diagnosed with unilateral stenosing ureteritis 8 weeks after the onset of HSP. In some cases, as in the case described by Siomou et al [18], ureteritis may be accompanied by nephritis, which may conceal underlying symptoms of ureteritis. This may result in delayed diagnosis of ureteritis and increased risk of complications.…”

Small vessel vasculitis

“…Multiple organ involvement may be present from the outset of the disease or, alternatively, an evolving pattern may develop, with different organs becoming involved at different time points over the course of several days to several weeks. One complication worth emphasizing for pediatric nephrologists is the rare but well-recognized complication of ureteric obstruction [13]. …”