Rapid progression and recovery of massive gastric mucosal damage complicated by Henoch-Schönlein purpura in a patient with liver cirrhosis: A case report

Abstract

Endoscopic findings associated with gastric ischemia include friable gastric mucosa, irregular ulceration, petechiae and purpura. The etiology of gastric ischemia includes shock, sepsis, thrombosis, embolism and vasculitis. Henoch-Schönlein purpura (HSP) is a leukocytoclastic vasculitis that affects small vessels in the skin, kidney and gastrointestinal (GI) tract. Rapid progression of HSP manifested with acute gastric mucosal bleeding has been rarely reported. The present case study reports on a patient who had undergone endoscopic variceal ligation for esophageal varix bleeding and the gastric mucosa exhibited no evidence of HSP. After 9 days, reexamination using endoscopy to check for new-onset hematemesis revealed massive necrosis in the gastric mucosa, friable mucosal tissue and acute ischemic GI bleeding. The patient was treated with corticosteroid injections for 7 days, which caused a marked regression of the hemorrhagic gastric mucosa. The present case study reported on this patient with acute GI bleeding caused by HSP who was successfully treated with corticosteroids.

Keywords: Henoch-Schönlein purpura; corticoisteroid; gastric ischemia; gastrointestinal; hemorrhage.

Figure 1.

Multiple petechiae on (A) lower legs and (B) hands.

Figure 1.

Multiple petechiae on (A) lower legs and (B) hands.

Figure 2.

Endoscopic image revealing diffuse bleeding from stomach and duodenum. (A) Diffuse mucosal friability, pethechiae and purpura at the corpus. (B) Diffuse blood oozing was noted at the corpus. (C) Linear, active duodenal ulcer at bulb.

Figure 2.

Endoscopic image revealing diffuse bleeding from stomach and duodenum. (A) Diffuse mucosal friability, pethechiae and purpura at the corpus. (B) Diffuse blood oozing was noted at the corpus. (C) Linear, active duodenal ulcer at bulb.

Figure 2.

Endoscopic image revealing diffuse bleeding from stomach and duodenum. (A) Diffuse mucosal friability, pethechiae and purpura at the corpus. (B) Diffuse blood oozing was noted at the corpus. (C) Linear, active duodenal ulcer at bulb.

Figure 3.

Abdominal computed tomography revealed diffuse edematous change at entire stomach with no occlusion of major vessels.

Figure 4.

Follow-up endoscopy indicating regression of mucosal friability, purpura and ulcer. (A) Regression of mucosal friability and purpura. (B) Completely healed duodenal ulcer.

Figure 4.

Follow-up endoscopy indicating regression of mucosal friability, purpura and ulcer. (A) Regression of mucosal friability and purpura. (B) Completely healed duodenal ulcer.