[Rheumatoid purpura (or Schoenlein-Henoch syndrome) and pregnancy. Review of the literature and a case report]

Abstract

Schönlein-Henoch purpura is a clinical syndrome of generalized vasculitis manifested by a petechial or ecchymotic purpuric skin rash, renal manifestations, abdominal pains (or gastro-intestinal bleedings) and arthralgias. This syndrome of unknown etiology usually occurs in children, predominantly in males, but has been reported in adults. Very little is known about the effect of this disorder on pregnancy and vice-versa. We report here our first case of Schönlein-Henoch purpura in a pregnant woman. A-38-year-old maghrebin woman gravida 4 para 3 was admitted to the hospital at 23 weeks'gestation with symmetrical arthralgias of the knees and ankles, and skin rash. Crops of nontender purpura were present on legs, buttocks and arms. The skin biopsy specimen revealed leukocytoclastic vasculitis with immunoglobulins A deposits. The prognosis has been excellent, kidney function was not compromised, and the outcome of the pregnancy was good. Only eight previous reports of Schönlein-Henoch purpura in pregnant women have been noted in the literature. The effect of pregnancy on the course of this syndrome remains unclear, and the treatment of relapses during pregnancy is unknown. Generally treatment is symptomatic only. The efficiency of steroid therapy has not been proved. During pregnancy the course of this disease is unforeseeable. Some patients' symptoms remain stable, other patients can suffer either new onset or exacerbation of the syndrome. The third trimester can be complicated by superimposed pregnancy induced hypertension, pre-eclampsia or eclampsia.