Korean J Med.  2007 Oct;73(4):453-456.

A case of henoch-Sch?nlein purpura complicated by hemorrhagic gastroenteritis and IgA nephropathy in a patient suffering with juvenile rheumatoid arthritis

• Shin J
• Lee YA
• Moon SY
• Woo DH
• Lee SH
• Hong SJ
• Yang HI

Abstract

Henoch-Sch?nlein purpura (HSP) is a systemic vasculitis with IgA dominant immune complex deposits that affect the small vessels in the skin, joints, gastrointestinal tract and kidneys. Gastrointestinal symptoms are common and the manifestations include abdominal pain, bleeding, bowel infarction, intussusceptions or even perforation. Polyarticular onset juvenile rheumatoid arthritis (JRA) is a rare form of arthritis that affects children and young adults. The relationship between HSP and JRA is uncertain. We report on a 24-year-old man with a history of polyarticular onset JRA and HSP that was complicated by hemorrhagic gastroenteritis. The gastroscopy and colonoscopic findings showed extensive hemorrhagic inflammatory changes of the gastric and intestinal mucosa. The patient had severe bloody diarrheal symptoms, abdominal pain and gross hematuria. The 24 hours urine chemistry profile showed the proteinuria was greater than 4.5 g/day, and immunofluorescent staining of the renal biopsy specimen showed diffuse granular mesangial deposits of IgA and C3. The abdominal manifestations and proteinuria were improved after methylprednisolone therapy.

Keyword

Henoch-Sch?nlein purpura; Polyarticular onset juvenile rheumatoid arthritis; Hemorrhagic gastritis; Hemorrhagic colitis; IgA nephropathy

MeSH Terms

Abdominal Pain
Antigen-Antibody Complex
Arthritis
Arthritis, Juvenile*
Biopsy
Chemistry
Child
Gastroenteritis*
Gastrointestinal Tract
Gastroscopy
Glomerulonephritis, IGA*
Hematuria
Hemorrhage
Humans
Immunoglobulin A*
Infarction
Intestinal Mucosa
Intussusception
Joints
Kidney
Methylprednisolone
Proteinuria
Purpura*
Skin
Systemic Vasculitis
Young Adult
Antigen-Antibody Complex
Immunoglobulin A
Methylprednisolone