[HTML][HTML] Henoch-Schönlein purpura from vasculitis to intestinal perforation: A case report and literature review

B Lerkvaleekul, S Treepongkaruna… - World journal of …, 2016 - ncbi.nlm.nih.gov
B Lerkvaleekul, S Treepongkaruna, P Saisawat, P Thanachatchairattana, N Angkathunyakul
World journal of gastroenterology, 2016ncbi.nlm.nih.gov
Henoch-Schönlein purpura (HSP) is generally a self-limited vasculitis disease and has a
good prognosis. We report a 4-year-old Thai boy who presented with palpable purpura,
abdominal colicky pain, seizure, and eventually developed intestinal ischemia and
perforation despite adequate treatment, including corticosteroid and intravenous
immunoglobulin therapy. Imaging modalities, including ultrasonography and contrast-
enhanced computed tomography, could not detect intestinal ischemia prior to perforation. In …
Abstract
Henoch-Schönlein purpura (HSP) is generally a self-limited vasculitis disease and has a good prognosis. We report a 4-year-old Thai boy who presented with palpable purpura, abdominal colicky pain, seizure, and eventually developed intestinal ischemia and perforation despite adequate treatment, including corticosteroid and intravenous immunoglobulin therapy. Imaging modalities, including ultrasonography and contrast-enhanced computed tomography, could not detect intestinal ischemia prior to perforation. In this patient, we also postulated that vasculitis-induced mucosal ischemia was a cause of the ulcer, leading to intestinal perforation, and high-dose corticosteroid could have been a contributing factor since the histopathology revealed depletion of lymphoid follicles. Intestinal perforation in HSP is rare, but life-threatening. Close monitoring and thorough clinical evaluation are essential to detect bowel ischemia before perforation, particularly in HSP patients who have hematochezia, persistent localized abdominal tenderness and guarding. In highly suspicious cases, exploratory laparotomy may be needed for the definite diagnosis and prevention of further complications.
ncbi.nlm.nih.gov
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