SEVERE GASTROINTESTINAL MANIFESTATIONS COMPLICATING HENOCH-SCHÖNLEIN PURPURA IN ADULT: A RARE CASE IN INDONESIA

  • William Ray Cassidy Department of Internal Medicine, Wangaya Regional General Hospital, Jalan Kartini No.133, Dauh Puri Kaja, Denpasar Utara, Dauh Puri Kaja, Denpasar Utara, Denpasar, Bali.
  • Ketut Suryana Department of Internal Medicine, Wangaya Regional General Hospital, Jalan Kartini No.133, Dauh Puri Kaja, Denpasar Utara, Dauh Puri Kaja, Denpasar Utara, Denpasar, Bali.
  • Dewi Catur Wulandari Department of Internal Medicine, Wangaya Regional General Hospital, Jalan Kartini No.133, Dauh Puri Kaja, Denpasar Utara, Dauh Puri Kaja, Denpasar Utara, Denpasar, Bali.

Abstract

Henoch-Schönlein purpura (HSP), also known as immunoglobulin A vasculitis, is a self-limiting, small vessel systemic vasculitis rarely found in adults characterized by palpable purpura, arthritis or arthralgia, gastrointestinal, and renal involvement. We report a case of a 31-year-old male with HSP complicated with severe gastrointestinal manifestations mimicking acute abdomen. He was successfully managed with conservative approach. Meticulous diagnosis, treatment, and long-term monitoring are important to reduce patient morbidity.

Keywords: Adult-onset Henoch-Schönlein Purpura, Severe bowel angina, Small vessel vasculitis.

References

1. Hung SP, Yang Yh, Lin YT, Wang LC, Lee JH, Chiang BL. Clinical manifestations and outcomes of henoch-schonlein purpura: Comparison between adults and children. Pediatr Neonatol 2009;50:162-8.
2. Kang Y, Park JS, Ha YJ, Kang MI, Park HJ, Lee SW, et al. Differences in clinical manifestations and outcomes between adult and child patients with Henoch-Schönlein purpura. J Korean Med Sci 2014;29:198-203.
3. Sohagia AB, Gunturu SG, Tong TR, Hertan HI. Henoch-Schonlein purpura-a case report and review of the literature. Gastroenterol Res Pract 2010;2010:597648.
4. Mills JA, Michel BA, Bloch DA, Calabrese LH, Hunder GG, Arend WP, et al. The American college of rheumatology 1990 criteria for the classification of Henoch-Schonlein purpura. Arthritis Rheum 1990;33:1114-21.
5. Audemard-Verger A, Pillebout E, Guillevin L, Thervet E, Terrier B. IgA vasculitis Henoch–Shonlein purpura in adults: Diagnostic and therapeutic aspects. Autoimmun Rev 2015;14:579-85.
6. Jithpratuck W, Elshenawy Y, Saleh H, Youngberg G, Chi DS, Krishnaswamy G. The clinical implications of adult-onset Henoch-Schonelin purpura. Clin Mol Allergy 2011;9:9.
7. Reamy BV, Williams PM, Lindsay TJ. Henoch-Schonlein purpura. Am Fam Physician 2009;80:697-704.
8. Pillebout E, Thervet E, Hill G, Alberti C, Vanhille P, Nochy D. Henoch-Schonlein Purpura in adults: Outcome and prognostic factors. J Am Soc Nephrol 2002;13:1271-8.
9. Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al. 2012 Revised international Chapel Hill consensus conference nomenclature of vasculitides. Arthritis Rheum 2013;65:1-11.
10. Djakovic I, Butorac D, Vucicevic Z, Kosec V, Kuna AT, Lugović-Mihić L. Henoch-Schönlein purpura in the third trimester of pregnancy. Biochem Med 2018;28:010801.
11. Ozen S, Pistorio A, Iusan SM, Bakkaloglu A, Herlin T, Brik R, et al. EULAR/PRINTO/PRES criteria for Henoch-Schonlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteria. Ann Rheum Dis. 2010;69:798-806.
12. Hočevar A, Rotar Z, Jurčić V, Pižem J, Čučnik S, Vizjak A, et al. IgA vasculitis in adults: The performance of the EULAR/PRINTO/PRES classification criteria in adults. Arthritis Res Ther 2016;18:58.
13. Yang YH, Yu H, Chiang B. The diagnosis and classification of Henoch-Schönlein purpura: An updated review. Autoimmun Rev 2014;13:355 8.
14. Joshisree KP, Rajesh G, Siddarama R: Corticosteroids induced ecchymosis. Int J Pharm Pharma Sci 2018;10:211-3.
15. Lakhsmi R, Liniya S, Vijayalakshmi S. Dapsone Induced hypersensitiity syndrome-a case report. Int J Pharm Pharm Sci 2015;7:585-7.
16. Sharma A, Wanchu A, Kalra N, Singh S, Bambery P. Successful treatment of severe gastrointestinal involvement in adult-onset Henoch-Schonlein purpura. Singapore Med J 2007, 48:1047-50.
17. Pozzi C, Andrulli S, Del Vecchio L, Melis P, Fogazzi GB, Altieri P, et al. Corticosteroid effectiveness in IgA nephropathy: Long-term results of a randomized, controlled trial. J Am Soc Nephrol 2004;15:157-63.
18. Lee BM, Jung HC, Bang SJ, Suh HS, Choi SW. A Case of Henoch-Schönlein Purpura complicated by hemorrhagic ascites. J Korean Rheum Assoc 2004;11:417-21.
19. García-Porrúa C, Calviño MC, Llorca J, Couselo JM, González-Gay MA, et al. Henoch-Schönlein purpura in children and adults: Clinical differences in a defined population. Semin Arthritis Rheum 2002;32:149-56.
Statistics
131 Views | 234 Downloads
Citatons
How to Cite
Ray Cassidy, W., K. Suryana, and D. Catur Wulandari. “SEVERE GASTROINTESTINAL MANIFESTATIONS COMPLICATING HENOCH-SCHÖNLEIN PURPURA IN ADULT: A RARE CASE IN INDONESIA”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 11, no. 11, Nov. 2018, pp. 11-15, doi:10.22159/ajpcr.2018.v11i11.28911.
Section
Case Study(s)