Henoch Schönlein purpura associated with pulmonary adenocarcinoma

Abstract

Introduction: Henoch-Schönlein purpura is a common immunoglobulin A-mediated vasculitis syndrome in children. Henoch-Schönlein purpura can also affect adults and is probably related to malignancy.

Case presentation: We report the case of a 61-year-old Japanese man who presented for examination after an abnormal shadow was detected by chest radiography. He received a diagnosis of pulmonary adenocarcinoma, stage IV. Purpura on the legs, abdominal pain, diarrhea, hematuria and proteinuria developed at this time. Henoch-Schönlein purpura was diagnosed, base on the clinical symptoms and histological findings of biopsy specimens of the skin, which showed vasculitis with immunoglobulin A deposits. Our patient received chemotherapy with gemcitabine after successful steroid therapy for the Henoch-Schönlein purpura.

Conclusion: Although hematological malignancies are well-known causes of vasculitides, cases of Henoch-Schönlein purpura associated with lung adenocarcinoma are rare. Our patient was treated with corticosteroid therapy, which cleared the purpura and cytotoxic chemotherapy for the non-small cell lung cancer. However, he died from heart failure due to cardiac tamponade.

Figure 1

Computed tomography (CT) scan of the chest on admission to our hospital. Tumor in the left upper lobe, swelling of mediastinal lymph nodes, and small nodules in both lung fields and pleura (arrows).

Figure 2

Computed tomography (CT) scan of the abdomen and pelvis on admission to our hospital. No evidence of metastasis but did identify diffuse swelling and thickening of the small intestine walls (arrows).

Figure 3

Histopathology of the palpable purpura. (A) Cellular infiltration into the obscured small vessel walls of the subpapillar plexus under the epidermis (hematoxylin and eosin, original magnification × 100). (B) Infiltration of polymorphonuclear cells (haematoxylin and eosin, original magnification × 150) (C) Fluorescent immunoglobulin A deposits (arrows) (original magnification × 100).