Myocarditis and intracardiac thrombus due to Henoch-Schönlein purpura: case report and literature review

Abstract

Cardiac involvement is very rare in patients with Henoch-Schönlein purpura (HSP). In this case study, we present an 8-year-old girl presenting with HSP-induced myocarditis and thrombus in the right atrium and HSP nephritis. To date, 15 cases of HSPrelated cardiac involvement have been reported in the PubMed/MEDLINE, Scopus, and Google Scholar databases. These cases, together with our case, are included in this review. We excluded those patients with other rheumatologic diseases (acute rheumatic fever, acute post-streptococcal glomerulonephritis, Kawasaki disease) accompanied by HSP. Three were children and 13 were adults and all were male except our case. This review revealed tachyarrhythmia, chest pain, dyspnea, murmur, and heart failure as the major signs. Cardiac tests, electrocardiogram (ECG), and imaging methods (echocardiography in all patients, cardiac magnetic resonance imaging (MRI) in three, cardiac biopsy in one, and post-mortem necropsy in three) showed that the cardiac involvements were pericardial effusion, intra-atrial thrombus, myocarditis, coronary artery changes, myocardial ischemia, infarction and necrosis, subendocardial hemorrhage, and left ventricular dilatation. Kidney involvement was not observed in three patients. As the treatment, high-dose prednisolone and cyclophosphamide, oral corticosteroid, azathioprine, nadroparin calcium, ACE inhibitors, calcium antagonists, beta-blockers, and diuretics were used. Eleven patients (all three children and eight of the adults) had a complete cardiac recovery. Cardiac involvement in adults was more likely to be fatal. Death (three patients), ischemia, and infarct have been reported only in adults. We suggested that early and aggressive treatment can be life-saving. MRI examination is effective at identifying cardiac involvement.

Compartment Syndrome: An Uncommon Twist in Childhood Henoch-Schönlein Purpura

“…This marks the first recorded instance of upper limb compartment syndrome in the context of HSP within our institution, adding to the two other cases documented in existing literature. Complications such as severe gastrointestinal bleeding, pulmonary hemorrhage [ 2 ], intracranial hemorrhage [ 3 ], bilateral occlusion of the central retinal artery [ 4 ], orbital hematomas, penile involvement [ 5 ], thrombosis [ 6 ], appendicitis, hemorrhagic bullous lesions [ 7 ], myocarditis, and intracardiac thrombus [ 8 ] have been previously reported.…”

Testicular ischemia associated with IgA vasculitis in a child: a case report and literature review

“…The incidence of IgAV is reported to range from 10 to 20 cases per 100,000 children (2). In general, children with IgAV have a good prognosis, but serious complications such as myocarditis and disorders of the nervous system (such as intracranial hemorrhage), respiratory system (such as pulmonary hemorrhage), and reproductive system (such as scrotal edema, orchitis, testicular torsion) may occur owing to individual differences (3)(4)(5)(6). Genital involvement in IgAV is infrequent, and testicular necrosis is extremely rare.…”