The clinical spectrum of Henoch-Schönlein purpura: insights from two distinct presentations
DOI:
https://doi.org/10.18203/issn.2455-4529.IntJResDermatol20252075Keywords:
Henoch-Schönlein purpura, Erythematous purpuric rash, GI vasculitis, Skin biopsy, GI bleed, Pulse steroid, CyclophosphamideAbstract
Henoch-Schönlein purpura (HSP), or IgA vasculitis, is an autoimmune small-vessel vasculitis caused by IgA immune complex deposition, primarily affecting children but rarely seen in adults. We present two contrasting cases to highlight its variable presentation and diagnostic challenges. The first case is a 44-year-old woman with recurrent purpuric rash, arthralgia, elevated CRP and ESR, and positive anti-RNP and anti-Sm antibodies, suggesting an autoimmune disorder. However, clinical features and biopsy confirmed IgA vasculitis. She was managed with corticosteroids, topical agents, and supportive care, emphasizing the need to distinguish HSP from other autoimmune diseases. The second case involves a 13-year-old girl with a known history of HSP who presented with hematemesis and melena. Investigations revealed marked leukocytosis, elevated CRP, and gastrointestinal involvement confirmed through endoscopy and biopsy, showing erosive gastritis and pancolitis consistent with GI vasculitis. She was treated with corticosteroid pulse therapy and cyclophosphamide. These cases demonstrate the spectrum of HSP in both adults and children and highlight the importance of correlating clinical symptoms with laboratory and imaging findings for timely and accurate diagnosis. They also reinforce the role of immunosuppressants in managing severe or refractory cases.
Metrics
References
Henoch-Schonlein purpura-a case report and review of the literature. Gastroenterol Res Pract. 2010;2010:597648. DOI: https://doi.org/10.1155/2010/597648
Roberts PF, Waller TA, Brinker TM, Riffe IZ, Sayre JW, Bratton RL. Henoch-Schönlein Purpura: A review article. South Med J. 2007;100(8):821-4. DOI: https://doi.org/10.1097/SMJ.0b013e3180f62d0f
Gedalia A. Henoch-Schönlein purpura. Curr Rheumatol Rep. 2004;6(3):195-202. DOI: https://doi.org/10.1007/s11926-004-0068-2
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-Schönlein purpura. Arthritis Rheum. 1990;33(8):1114-21. DOI: https://doi.org/10.1002/art.1780330809
Castañeda S, Quiroga-Colina P, Floranes P, Uriarte-Ecenarro M, Valero-Martínez C, Vicente-Rabaneda EF, et al. IgA vasculitis (Henoch–Schönlein Purpura): An update on treatment. J Clin Med. 2024;13(21):6621. DOI: https://doi.org/10.3390/jcm13216621
Roache-Robinson P, Killeen RB, Hotwagner DT. IgA vasculitis (Henoch-Schönlein Purpura). In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2025.
Xu L, Li Y, Wu X. IgA vasculitis update: Epidemiology, pathogenesis, and biomarkers. Front Immunol. 2022;13:921864. DOI: https://doi.org/10.3389/fimmu.2022.921864
Hetland LE, Susrud KS, Lindahl KH, Bygum A. Henoch-Schönlein Purpura: A literature review. Acta Derm Venereol. 2017;97(10):1160-6. DOI: https://doi.org/10.2340/00015555-2733
Gicchino MF, Iafusco D, Marrapodi MM, Melone R, Cuomo G, Zanfardino A, et al. Gastrointestinal Henoch-Schönlein purpura successfully treated with Mycophenolate Mofetil: Description of 2 case reports. Medicine (Baltimore). 2021;100(1):e24093. DOI: https://doi.org/10.1097/MD.0000000000024093
Uluca Ü, Ece A, Şen V, Yel S, Tan İ, Karabel D. Management of intestinal bleeding with single-dose cyclophosphamide in Henoch-Schönlein purpura: Intestinal bleeding in HSP. Pediatr Int. 2015;57(3):498-500. DOI: https://doi.org/10.1111/ped.12670
Guo H, Wang Z-L, Tao Z. Delayed diagnosis of abdominal Henoch-Schonlein purpura in children: A case report. World J Clin Cases. 2023;11(26):6311-7. DOI: https://doi.org/10.12998/wjcc.v11.i26.6311
Wang S, Tang H, Du W, Ding Y. Massive gastrointestinal hemorrhage caused by Henoch-Schoenlein purpura: A case report: A case report. Medicine (Baltimore). 2021;100(50):e28240. DOI: https://doi.org/10.1097/MD.0000000000028240
Kusumawati NRD, Pratiwi J, Low SL, Paramitha DA, Prawirasatra WA, Pratiwi NR, et al. Ulcerative Colitis with Henoch Schonlein Purpura in Pediatric Patient: A Case-Report. Arch Pediatr Gastr Hepatol Nutr. 2023;2(4):30-5. DOI: https://doi.org/10.58427/apghn.2.4.2023.30-5
Li Y, Zhang X, Liu H, Li G, Guan W, Zhang T, et al. Severe gastrointestinal involvement in pediatric IgA vasculitis: a retrospective single-center cohort study in China. Front Pediatr. 2023;11:1194214. DOI: https://doi.org/10.3389/fped.2023.1194214