Kosin Med J.  2012 Jun;27(1):45-49. 10.7180/kmj.2012.27.1.45.

A Case of Henoch Schonlein Purpura with Gastrointestinal Bleeding Due to Jejunal Ulcer by Capsule Endoscopy

• Lee YK
• Oh TK
• Choi A
• Lee JH
• Kim MN
• Hong SP

• KMID: 1993586
• DOI: http://doi.org/10.7180/kmj.2012.27.1.45

Abstract

Henoch-Schonlein purpura (HSP) is the most common form of systemic vasculitis in children. Palpable purpura, arthralgia, arthritis, abdominal pain and renal involvement are the major clinical manifestations. Gastrointestinal involvement is related with abdominal pain and bleeding. We described a 71 year-old female experienced acute exacerbation of HSP presented with gastrointestinal bleeding. She was hospitalized for hematemesis and diagnosed duodenitis by esophagogastroduonenoscopy (EGD). Duodenitis was improved at EGD checked in 7 days. She still complained of melena and abdominal pain. There were no abnormal findings at sigmoidoscopy. Jejunal ulcer and purpura were diagnosed by capsule endoscopy. Symptoms were relieved after administration of systemic steroid. But she needed renal replacement therapy for 3 months. Small bowel ulcer diagnosed by capsule endoscopy in patients with HSP was rarely described in Korean literature. This case suggests that capsule endoscopy have a role in diagnosis of small bowel ulcer and its severity in HSP with gastrointestinal symptom.

Keyword

Capsule endoscopy; Gastrointestinal hemorrhage; Henoch-Schonlein pupura

MeSH Terms

Abdominal Pain
Arthralgia
Arthritis
Capsule Endoscopy
Child
Duodenitis
Female
Gastrointestinal Hemorrhage
Hematemesis
Hemorrhage
Humans
Melena
Purpura
Purpura, Schoenlein-Henoch
Renal Replacement Therapy
Sigmoidoscopy
Systemic Vasculitis
Ulcer

Figure

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  Fig. 1 Esophagogastroduodenoscopy (EGD) findings. (A) EGD showed mild chronic superficial gastritis (B) EGD showed severe duodenitis from bulb to 2nd portion of duodenum.

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  Fig. 2 Capsule endoscopy showed multiple ulcer and erosions, multiple erythematous lesion and ulcer at Jejunum

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  Fig. 3 Light microscopic finding of skin biopsy taken outpatients clinic before 3 years ago. They show leukocytoclastic vasculitis. (A) HE stain × 40HE (B) stain × 200

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  Fig. 4 light microscopic finding of renal biopsy. (A) glomeruli show global sclerosis. And tubular atrophy was seen (B) glomeruli associated with fibrocellular/cellular crescents. The glomerular basement membrane is not thickened

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