Henoch-Schönlein Purpura begin with severe gastrointestinal involvement

Abstract

Introduction: Henoch-Schönleinpurpura (HSP) is the most common vasculitis of childhood and is a multisystemic disease which is characterized by skin, joint, gastrointestinal (GI) and renal small vessels involvement.

Case: Seven-year-old male patient was admitted with complaints of nausea and vomiting and abdominal pain started three days ago. Laparotomy was performed to the patient with the diagnosis of acute abdominal pain. Any other pathology than the jejunum edema was observed in the first 10 cm field was not observed. Appendectomy performed and abdomen was closed. Postoperative fifth day pain in the knee joint and melena had occurred. In the lower and upper gastrointestinal endoscopy, diffuse hyperemia and hemorrhage were observed in the gastric mucosa, duodenum and rectum. Intravenous steroids treatment was started. Skin rashes were observed on the arms of the patient at 11. day of hospitalization. The patient who response to steroid therapy was discharged with healing at the 15th day of hospitalization.

Discussion: Purpuric skin lesions are the most common finding in the HSP and generally observed before the GI involvement. In the situation of the GI involvement occurred before the skin involvement, the abdominal pain might be similar to the appendicitis pain.

Key words: Henoch-Schönlein Purpura, severe system involvement, gastrointestinal bleeding. 

Keywords

• Henoch-Schönlein purpura, severe system involvement, gastrointestinal bleeding.CİLT: 45 YIL: 2014 SAYI: 4ZEYNEP KAMİL TIP BÜLTENİ 2014;45:204-7

Ağır gastrointestinal sistem tutulumu ile başlayan Henoch-Schönlein Purpurası

Öz

Giriş-Amaç: Henoch-Schönlein purpurası (HSP), çocukluk çağının en sık görülen vasküliti olup, cilt, eklem, gastrointestinal sistem (GİS) ve böbreklerdeki küçük çaplı damarların tutulumuyla karakterize multisistemik bir hastalıktır.

Olgu: Yedi yaşında, erkek hasta 3 gün önce başlayan karın ağrısı, bulantı ve kusma şikâyetleri ile başvurdu. Akut batın tanısı ile hastaya laparatomi uygulandı ve jejenum ilk 10 cm’lik alanda öem dışıda patoloji göümedi. Apendektomi yapıarak batı kapatıdı Postoperatif beşnci güde diz ekleminde ağıve melenasıoldu. Alt ve üt Gİ endoskopisinde gastrik mukoza, duedonum ve rektumda diffü hiperemi ve kanama izlendi. Vasküit tanııile intravenö steroid tedavisi başandı Hastada yatışıı 11.güüde kollarıda deri döütüeri izlendi. Steroid tedavisine yanı alıan hasta yatışıı 15. güüşfa ile taburcu edildi.

Tartışma - Sonuç: HSP de purpurik cilt lezyonları en yaygın bulgu olup genellikle GİS tutulumundan önce görülür. GİS tutulumu cilt tutulumundan önce görüldüğü durumlarda karın ağrısı apandisit tablosuna benzemektedir.

Anahtar kelimeler: Henoch-Schönlein purpurası, ağır sistem tutulumu, GİS kanama

Anahtar Kelimeler

• Henoch-Schönlein purpurası, ağır sistem tutulumu, GİS kanama.

Kaynakça

1. Katz S, Borst M, Seekri I, Grosfeld JL. Surgical evaluation of Henoch-Schönlein purpura: Experience with 110 children. Arch Surg 1991;126: 849-54.
2. Lahita RG. Influence of age on Henoch Schönlein purpura. Lancet 1997; 350:1116-7.
3. Gunasekaran TS. Henoch-Schönlein purpura, what does the "rash" look like in the gastrointestinal mucosa? Pediatr Dermatol. 1997;14:437-40.
4. Peru H, Soylemezoglu O, Bakkaloglu SA, et al. Henoch Schonlein purpura in childhood: clinical analysis of 254 cases over a 3-year period. Clin Rheumatol. 2008;27:1087-92.
5. Chong CK, Beasley SW. Intra-abdominal manifestations of Henoch-Schönlein purpura. J Paediatr Child Health. 1998;34:405-9.
6. Saulsbury FT. Henoch-Schönlein purpura in children: Report of 100 patients and review of the literature. Medicine 1999;78:395-409.
7. Sohagia AB, Gunturu SG, Tong TR, et al. Henoch-schonlein purpura-a case report and review of the literature. Gastroenterol Res Pract. 2010; 2010:597648.
8. Cheungpasitporn W, Jirajariyavej T, Howarth CB, et al. Henoch-Schönlein purpura in an older man presenting as rectal bleeding and IgA mesangioproliferative glomerulonephritis: a case report. J Med Case Rep. 2011; 5:364.

9. Hamzaoui A, Melki W, Harzallah O, et al. Gastrointestinal involvement revealing Henoch Schonlein purpura in adults: Report of three cases and review of the literature. Int Arch Med 2011;4:31.
10. Jangjoo A, Amouzeshi A, Jalali AN. Gangrenous appendicitis in a child with Henoch-Schonlein purpura. J Pediatr Surg. 2008;43:33-5.
11. Kim CJ, Chung HY, Kim SY et al. Acute appendicitis in Henoch-Schonlein purpura: a aase report. J Korean Med Sci 2005; 20: 899-900.
12. Kawasaki Y, Suzuki J, Sakai N. et al. Clinical and pathological features of children with Henoch- Schoenlein purpura nephritis: risk factors associated with poor prognosis. Clin Nephrol 2003;60:153-60.