Pneumatosis Intestinalis Associated With Henoch–Schönlein Purpura

Abstract

Henoch-Schönlein purpura (HSP) is the most common vasculitis in children. It is a disorder of the inflammatory cascade leading to immunoglobulin A deposition and leukocytoclastic vasculitis of small vessels of skin, kidneys, joints, and gastrointestinal (GI) tract. A wide variety of GI manifestations are seen in ∼50% to 75% of patients with HSP. Diffuse colicky abdominal pain is the most common GI symptom. The small bowel is the most frequently involved GI site. Intussusception is rare but is the most common surgical complication. We report the case of a 2-year-old girl with a 5-day history of abdominal pain followed by a palpable purpuric rash. Her urinalysis, complete blood cell count, and tests of renal function were normal. An acute abdominal series was unremarkable initially, and abdominal ultrasound imaging showed ascites and thickened small bowel loops. She was diagnosed with HSP. The abdominal pain worsened, and an abdominal computed tomography scan demonstrated distal small bowel wall thickening and pneumatosis intestinalis in the descending colon. She was started on total parenteral nutrition and antibiotics and placed on bowel rest. She was given 2 mg/kg of intravenous immunoglobulin. Her abdominal pain gradually improved over the next week, and a repeat computed tomography scan showed significant improvement of the small bowel wall thickening and pneumatosis. The purpuric rash improved, and her abdominal pain resolved. We report a case of HSP and pneumatosis intestinalis, an association that has not been reported previously. Pediatrics 2014;134:e880-e883 AUTHORS:

Effect of different protein diet on the prognosis of children with immunoglobulin A vasculitis

“…Children at this stage were in a critical period of growth and development. If the protein supply of children with IgAV were insu cient for a long time, which can lead to anorexia, weight loss and even malnutrition 13 Moreover, gastrointestinal tract, the largest gathering place of human immune system, participates in human immune response 14 . Fasting protein for a long time may break the normal immune response of gastrointestinal tract and affect the prognosis of IgAV.…”

Effect of different protein diet on the prognosis of children with Henoch-Schönlein Purpura

“…If the protein supply of children with HSP were insu cient for a long time, which can lead to anorexia, weight loss and even malnutrition. 13 Moreover, gastrointestinal tract, the largest gathering place of human immune system, participates in human immune response. 14 Fasting protein for a long time may break the normal immune response of gastrointestinal tract and affect the prognosis of HSP.…”

Point-of-care ultrasound identification of pneumatosis intestinalis associated with Henoch-Schönlein purpura gastrointestinal involvement: A case report

“…[4] There is only one published pediatric case study on PI associated with HSP gut vasculitis. [5] This was detected by computed tomography (CT). There was an adult case report with HSP terminal ileitis and presented with symptoms mimicking appendicitis.…”