Rapidly Progressing Glomerulonephritis Secondary to Henoch-Schonlein Purpura Treated With Mycophenolate Mofetil: A Case Report With Atypical Etiology and Presentation

Abstract

Henoch-Schonlein purpura (HSP) is an acute leukocytoclastic vasculitis that primarily affects children but also affects approximately 1% of adults. We discuss a case of HSP that started after pantoprazole ingestion. Clinical manifestation included terminal ileitis and rapidly progressing glomerulonephritis. To our knowledge, this is the first reported case of HSP secondary to pantoprazole ingestion. The patient presented with renal failure requiring hemodialysis and was initially unresponsive to intravenous pulse steroids. The patient was treated with mycophenolate mofetil, and his renal function recovered. There are limited data regarding use of mycophenolate mofetil for treating crescentic glomerulonephritis secondary to HSP.

Treatment of children with Henoch-Schönlein purpura nephritis with mycophenolate mofetil

“…There are some reports of the successful use of MMF for IgA nephropathy in adults [15,19]. However, there are only a few reports of the use of MMF to treat HSP [20] and HSPN [21,22].…”

The Combination of Mycophenolate Mofetil with Corticosteroids Induces Remission of Henoch-Schönlein Purpura Nephritis

“…According to the experience of MMF treatment in patients of microscopic polyangiitis with severe renal impairment in our center [11], MMF can effectively induce remission and may result in a relatively rapid response on renal function. In literature, there was successful treatment of MMF for the HSPN limited to a single case or a small series [9,13,14,15,16]. The recent case series [9] of MMF management for HSPN included 12 children.…”

“…There are few reports about the usage of MMF in HSP [13,14] and HSPN [9,15,16] (table 1), limited to single case reports or small cases series. Recently, Du et al [9] treated 12 pediatric HSPN patients with MMF who failed steroid treatment.…”

Henoch-Schönlein purpura in an adult patient: a clinical case with dramatic presentation

“…Leczenie glikokortykosteroidami rozpoczyna się w chwili wystąpienia nasilonych objawów. Dotychczas nie osiągnię -to konsensusu co do leczenia kłębuszkowego zapalenia nerek w przebiegu HSP [17,18]. W razie dużego białkomoczu, a zwłaszcza zespołu nerczycowego, stosuje się dożylne pulsy metyloprednizolonu, a następnie prednizon doustnie.…”