Henoch-Schönlein vasculitis in an adult presenting with upper gastrointestinal bleeding - endoscopic findings: A case report

Abstract

While Henoch–Schönlein purpura is the most common acute systemic vasculitis in childhood, it is rare in adults. It affects small vessels and is the most common cause of palpable purpura. In adults, the gastrointestinal system and kidneys are the most common sites of involvement after the skin. Gastrointestinal bleeding is usually occult; massive gastrointestinal bleeding is rare. We report a case who admitted to our clinic with the complaint of abdominal pain who presented massive upper gastrointestinal bleeding and disrupted hemodynamics after hospitalization.

Keywords

• Henoch-Schönlein vasculitis, upper gastrointestinal bleeding.

Yetişkin yaşta akut üst gastrointestinal sistem kanaması ile prezente olan Henoch-Schönlein vasküliti, endoskopik bulguları: Olgu sunumu

Öz

Henoch –Schönlein purpurası çocuklarda en sık görülen vaskülit iken, eriş-kinde nadir görülen sistemik vaskülittir. Küçük damarları etkiler ve sıklıkla palpabl purpura ile prezente olur. Yetişkinde cilt tutulumu sonrası en fazla böbrek ve gastrointestinal tutulum olur. Gastrointestinal tutulumda sıklıkla gastrointestinal kanama gözlenir fakat masif gastrointestinal kanama nadirdir. Karın ağrısı şikayeti ile polikliniğimize başvuran ve yatışı sonrasında hemodinamiyi bozan masif üst gastrointestinal kanama görülen erişkin erkek olgu sunulmuştur.

Anahtar Kelimeler

• Henoch-Schönlein vaskülit, üst gastrointestinal kanama

Kaynakça

1. Başak M, Erden A, Bulut K, et al Gastrointestinal kanama ile başvuran erişkin başlangıçlı Henoch-Schönlein vasküliti ve ankilozan spondilitli bir olgu (A case with adult-onset Henoch-Schönlein vasculitis present- ing with gastrointestinal bleeding and ankylosing spondylitis). Endos- copy Gastrointestinal 2013;21:19-21.
2. Shin JI, Lee JS. Comment on: Clinical and histopathological features in Henoch-Schönlein purpura (Int J Dermatol 2008 January; 47(1):48-9.). Int J Dermatol 2008;47:1088.
3. Jinga M, Jurcut C, Vasilescu F, et al. A rare case of digestive hemorrhage in an elderly patient: diagnosis and treatment difficulties. Rom J Mor- phol Embryol 2012;53(3 Suppl):831-4.
4. Uppal SS, Hussain MA, Al-Raqum HA, et al. Henoch-Schönlein’s pur- pura in adults versus children/adolescents: A comparative study. Clin Exp Rheumatol 2006;24(2 Suppl 41):S26-30.
5. Calvo-Río V, Loricera J, Martín L, et al. Henoch-Schönlein purpura nephritis and IgA nephropathy: a comparative clinical study. Clin Exp Rheumatol 2013;31(1 Suppl 75):S45-51.
6. Pillebout E, Thervet E, Hill G, et al. Henoch-Schönlein purpura in adults: outcome and prognostic factors. J Am Soc Nephrol 2002;13:1271-8.
7. Akay BN, Ünlü e, Şanlı H, Akyol A. Erişkinlerde Henoch-Schönlein purpurasının klinik özellikleri ve takip sonuçları (Henoch-Schönlein purpura in adults: clinical features and outcome). Asthma Allergy Im- munol 2010;8:38-45.
8. García-Porrşa C, Calviño MC, Llorca J, et al. Henoch-Schönlein purpura in children and adults: clinical differences in a defined population. Se- min Arthritis Rheum 2002;32:149-56.

9. Ueo T, Nakase H, Chiba T. Clinical challenges and images in GI. Unique gastrointestinal involvement in a patient with Henoch-Schonlein pur- pura. Gastroenterology 2007;133:1076, 1395.
10. Zhang Y, Huang X. Gastrointestinal involvement in Henoch-Schönlein purpura. Scand J Gastroenterol 2008;43:1038-43.
11. Chen MJ, Wang TE, Chang WH, et al. Endoscopic findings in a patient with Henoch-Schonlein purpura. World J Gastroenterol 2005;11:2354- 6.
12. Sharma A, Wanchu A, Kalra N, et al. Successful treatment of severe gastrointestinal involvement in adult-onset Henoch-Schonlein purpura. Singapore Med J 2007;48:1047-50.
13. Ronkainen J, Koskimies O, Ala-Houhala M, et al. Early prednisone therapy in Henoch-Schönlein purpura: a randomized, double-blind, placebo-controlled trial. J Pediatr 2006;149:241-7.
14. Pavlović M, Radlović N, Leković Z, et al. Corticosteroid therapy in He- noch-Schönlein gastritis. [Article in Serbian]. Srp Arh Celok Lek 2007; 135:208-11.
15. Chen MJ, Chang WH, Chu CH, et al. Rapid response of Henoch-Schön- lein purpura to corticosteroids: correlation between skin and gastric mu- cosal lesions. Dig Dis Sci 2007;52:1706-8.
16. Farah R, Shay M. Gastrointestinal involvement in Henoch-Schönlein purpura. Minerva Gastroenterol Dietol 2007;53:295-9.