Henoch-schonlein purpura-a case report and review of the literature

Abstract

We describe a case of an adolescent male with Henoch-Schonlein purpura (HSP), presenting with cutaneous and gastrointestinal manifestations. Endoscopy revealed diffuse ulcerations in the stomach, duodenum, and right colon. Biopsies revealed a leukocytoclastic vasculitis in the skin and gastrointestinal tract. Steroid therapy led to complete resolution of the symptoms. HSP is the most common childhood vasculitis, and is characterized by the classic tetrad of nonthrombocytopenic palpable purpura, arthritis or arthralgias, gastrointestinal and renal involvement. It is a systemic disease where antigen-antibody (IgA) complexes activate the alternate complement pathway, resulting in inflammation and small vessel vasculitis. Mild disease resolves spontaneously, and symptomatic treatment alone is sufficient. Systemic steroids are recommended for moderate to severe HSP. The prognosis depends upon the extent of renal involvement, which requires close followup. Early recognition of multiorgan involvement, especially outside of the typical age group, as in our adolescent patient, and appropriate intervention can mitigate the disease and limit organ damage.

Figure 1

Clinical picture of palpable purpura involvement of bilateral lower extremities.

Figure 2

Clinical picture of palpable purpura involvement of bilateral upper extremities.

Figure 3

Endoscopic finding on EGD showing inflammation, submucosal hemorrhage, and small ulceration.

Figure 4

Small bowel biopsy showing preserved villous architecture.

Figure 5

Histopathology of HSP involvement in small bowel showing neutrophilic and eosinophilic infiltrates which are seen with karyorrhectic debris.

Figure 6

Histopathology of HSP involvement in skin showing microabscess.

Figure 7

Schematic diagram of HSP pathophysiology.