RETROSPECTIVE EVALUATION OF HENOCH SCHONLEIN PURPURA CASES

Year 2001, Volume: 14 Issue: 2, 101 - 106, 03.12.2016

Nurdan Erol Aysu Türkmen Can Erzik Ahmet Özgüner Serpil Yavrucu

Abstract

Objective: Henoch Schonlein Purpura (HSP) is the most common benign vasculitis occurring during childhood. Morbidity and mortality rates rise when there is organ system involvement. We aimed to retrospectively evaluate HSP cases in our clinic according to organ involvement, clinical and laboratory findings.
Material and Methods: Twenty-eight HSP cases were followed in our clinic from January 1st 1997 to June 1st 2000. The cases were retrospectively evaluated.
Results: The mean age of the patients was 7.96 years (interval: 3-14 yrs.). 17 of them were males, 11 were females. The mean hospitalization period was 6,36 days (interval: 1- 16 days). Two patients had been hospitalized twice due to recurrence and two others had each been hospitalized once before in another clinic due to the same disease. 9 patients (32.1 %) had a history of an upper respiratory tract infection (URTI) of whom 3 (10.7 %) had positive throat cultures for beta hemolytic streptococcus. Skin lesions were seen in all patients. Arthritis/arthralgia developed in 12 (42.9 %) patients. Gastrointestinal system tract (GIT)
involvement developed in 19 patients (67.9 %), 7 (25 %) of them presented with abdominal pain and vomiting, 12 (42.9 %) with occult fetal blood. In 4 patients (14.3 %) with GIT involvement, hematochezia and melena developed later. Abdominal ultrasonography was performed on 17 cases (60.7 %). No surgical intervention was required for any of the patients. 11 patients (39,3 %) had renal involvement. In 8 of the cases (28,6 %) renal disease presented with microscopic hematuria with or without proteinuria and in the other 3 (10,7 %) with macroscopic hematuria. In 1 (3.6 %) case acute renal failure developed and hemodialysis was performed. Central nervous system (CNS) involvement occurred in one patient (3,6 %) who had convulsions. In 2 cases (7.1%) scrotal involvement was observed. 13 patients were given steroids.
Conclusions: In HSP cases, renal and GIT involvement should be searched for meticulously and patients with renal involvement should be followed up regularly.
Key Words: Henoch Schonlein Purpura, HSP nephritis, Vasculitis, Gastrointestinal bleeding.

References

• Behrman RE, Robert MB, Waldo EN, Victor CV. Nelson Textbook of Pediatrics. 16th Edition. Philadelphia: PW.B. Saunders Co., 2000:628- 629.
• Tizard EJ. Henoch-Schönlein purpura. Arch Dis Child 1999;80:380-383.
• Watts RA, Scott DQI. Vasculitis. Bail Here's Clin Rheumatol 1995;9:529-545.
• Ece A, Gürkan F, Haspolat K, Katar S. Henoch- Schönlein purpurah çocuklarda renal ve gastrointestinal tutulum. Çocuk Sağ ve Hast Der (Hacettepe) 2000;43:36-42.
• Egan CA, Oreilly MA, Meadows KP, Zone JJ. Relapsing Henoch-Schönlein purpura associated with Pseudomonas aeruginosa pyelonephritis. J Am Acad Dermatol 2000;42;Pt2:381 -383.
• Kraft DM, Mckee D, Scott C. Henoch-Schönlein purpura: a review. Am Earn Physician 1998;58:405-411.
• Mat C, Yurdakul S, Tüzüner N, Tüzün Y. Vasculitis. Bailiere's Clin Rheumatol, 1997;11:244-246.
• Saulsbury FT. Henoch-Schonlein purpura in children: report of 100 patient literature. Medicine (Baltimore) 1999;78:395-409.
• Kumar L, Singh S, Goraya JS, et al. Henoch-
• Schönlein purpura: the Chandigarh
• experience. Indian Pediatr 1998;35:19-25.
• Blanco R, Martinez TVM, Rodriquez VV, et at. Henoch-Shönlein purpura in adulthood and childhood: two different expressions of the
• same syndrome. Arthritis Rheum 1997;40:859-864.
• Saulsbury FT. Henoch-Schonlein purpura. Curr Opin Rheum 2001 ; 13:35-40.
• Rovel-Guitera P, Diemert MC, Charnel JL, et al.
• IgA antineutrophil cytoplasmic antibodies in cutaneous vasculitis. Br J Dermatol
• ,143:99-103.
• Choong CK, Beasley SH/. Intraabdominal manifestations of Henoch-Schonlein purpura. J Paediatr Child Health 1998;34:405-409.
• Muller D, Greve D, Eggert P. Early tubular proteinuria and the development of nephritis in Henoch-Schonlein purpura. Pediatr Nephrol 2000;15:85-89.
• Ben-Sira L, Laor T. Servere scrotal pain in
• boys with Henoch-Schonlein
• purpurauncidence and sonography. Pedatr Radiol 2000;30:125-128.
• Agraharkar M, Gokhale S, Le L, et al. Cardiopulmonary manifestations of Henoch- Schonlein purpura. Am J Kidney Dis 2000;35:319-322.
• Dudley J, Afifi E, Gardner A, et al. Polymorphism of the ACE gene in Henoch- Schonlein purpura nephritis. Pediatr Nephrol 2000;14:218-220.
• Endo M, Ohi H, Ohsawa 1, et al. Complement activation through the lectin pathway in patients with Henoch-Schonlein purpura nephritis. Am J Kidney Dis 2000:35:401-407.
• Goldstein AR, White RHR, Akuse R, Chantier
• C. Long-term follow-up of childhood Henoch- Schonlein nephritis. The Lancet 1992;339:280-282.
• Reinehr T, Burk G, Berger T, et al. Steroids for prophylaxis of nephropathy in Schnlein Henoch purpura? Follow-up of 171 patients (Abstract). Klin Pediatr 2000;212:99-102.
• Foster BJ, Bernard C, Drummond KN, Sharma
• AK. Effective theraphy for severe Henoch- Schonlein purpura nephritis with prednisolone and azathioprine:a clinical and histopathological study. J Pediatr 2000;136:370-375.