The clinical implications of adult-onset henoch-schonelin purpura

Clinical and Molecular Allergy - Tập 9 - Trang 1-7 - 2011
Warit Jithpratuck1, Yasmin Elshenawy2, Hana Saleh1, George Youngberg2, David S Chi1, Guha Krishnaswamy1,3
1Departments of Internal Medicine, Quillen College of Medicine, East Tennessee State University, USA
2Department of Pathology, Quillen College of Medicine, East Tennessee State University, USA
3The James H. Quillen VA Medical Center, Johnson City, USA

Tóm tắt

Henoch-Schonlein Purpura (HSP) is a small vessel vasculitis mediated by IgA-immune complex deposition. It is characterized by the clinical tetrad of non-thrombocytopenic palpable purpura, abdominal pain, arthritis and renal involvement. Pathologically, it can be considered a form of immune complex-mediated leukocytoclastic vasculitis (LCV) involving the skin and other organs. Though it primarily affects children (over 90% of cases), the occurrence in adults has been rarely reported. Management often involves the use of immunomodulatory or immune-suppressive regimens.

Tài liệu tham khảo

Sohagia AB: Henoch-schonlein purpura-a case report and review of the literature. Gastroenterol Res Pract. 2010, 2010: 597648. Reamy BV, Williams PM, Lindsay TJ: Henoch-Schonlein purpura. Am Fam Physician. 2009, 80: 697-704. Hung SP: Clinical manifestations and outcomes of Henoch-Schonlein purpura: comparison between adults and children. Pediatr Neonatol. 2009, 50: 162-168. 10.1016/S1875-9572(09)60056-5 Lopez Meiller MJ: Henoch-Schonlein Purpura in adults. Clinics (Sao Paulo). 2008, 63: 273-276. Saulsbury FT: Henoch-Schonlein purpura in children. Report of 100 patients and review of the literature. Medicine (Baltimore). 1999, 78: 395-409. 10.1097/00005792-199911000-00005. Helander SD, De Castro FR, Gibson LE: Henoch-Schonlein purpura: clinicopathologic correlation of cutaneous vascular IgA deposits and the relationship to leukocytoclastic vasculitis. Acta Derm Venereol. 1995, 75: 125-129. Hong YH: Renal cell carcinoma presenting as Henoch-Schonlein purpura with leukocytoclastic vasculitis, hematuria, proteinuria and abdominal pain. Rheumatol Int. 2010, 30: 1373-1376. 10.1007/s00296-009-1063-8 Hoshino C: Adult onset Schonlein-Henoch purpura associated with Helicobacter pylori infection. Intern Med. 2009, 48: 847-851. 10.2169/internalmedicine.48.1718 Mitsui H: A clinical study of Henoch-Schonlein Purpura associated with malignancy. J Eur Acad Dermatol Venereol. 2009, 23: 394-401. 10.1111/j.1468-3083.2008.03065.x Sugimoto T: Henoch-Schonlein purpura in a patient with human immunodeficiency virus infection. Rheumatol Int. 2008, 28: 615-616. 10.1007/s00296-007-0492-5 Shin JI, Lee JS: Hepatitis B virus infection and Henoch-Schonlein purpura. J Dermatol. 2007, 34: 156. 10.1111/j.1346-8138.2006.00240.x Kunicka A, Pruszczyk P, Kryst A: Henoch-Schonlein purpura: an atypical cause of abdominal pain in a 70-year-old man: case report. Pol Arch Med Wewn. 2009, 119: 509-513. Goel SS, Langford CA: A 72-year-old man with a purpuric rash. Cleve Clin J Med. 2009, 76: 353-360. 10.3949/ccjm.76a.09141 Diehl MP, Harrington T, Olenginski T: Elderly-onset Henoch-Schonlein purpura: a case series and review of the literature. J Am Geriatr Soc. 2008, 56: 2157-2159. 10.1111/j.1532-5415.2008.01983.x Maripuri S, Fervenza FC: 71-year-old man with shortness of breath and rash. Mayo Clin Proc. 2008, 83: 1388-1391. 10.4065/83.12.1388 Grivceva-Panovska V, Grivceva SK, Serafimoski V: Henoch-Schonlein purpura in an adult patient: extragastric, cutaneous manifestation of helicobacter pylori infection. Prilozi. 2008, 29: 291-301. Knoll BM, Valles A, Hogan MC: 56-Year-old man with rash, abdominal pain, and arthralgias. Mayo Clin Proc. 2007, 82: 745-748. 10.4065/82.6.745 Kellerman PS: Henoch-Schonlein purpura in adults. Am J Kidney Dis. 2006, 48: 1009-1016. 10.1053/j.ajkd.2006.08.031 Pillebout E: Henoch-Schonlein Purpura in adults: outcome and prognostic factors. J Am Soc Nephrol. 2002, 13: 1271-1278. 10.1097/01.ASN.0000013883.99976.22 Patrignelli R, Sheikh SH, Shaw-Stiffel TA: Henoch-Schonlein purpura. A multisystem disease also seen in adults. Postgrad Med. 1995, 97: 123-124. Gatselis NK: Primary biliary cirrhosis and Henoch-Schonlein purpura: report of two cases and review of the literature. Liver Int. 2007, 27: 280-283. 10.1111/j.1478-3231.2006.01402.x Goda F: Colo-colic intussusception associated with Henoch-Schonlein purpura in adults. J Gastroenterol Hepatol. 2007, 22: 449-452. 10.1111/j.1440-1746.2006.03323.x Zhang Y, Huang X: Gastrointestinal involvement in Henoch-Schonlein purpura. Scand J Gastroenterol. 2008, 43: 1038-1043. 10.1080/00365520802101861 Amoli MM: Interleukin 1 receptor antagonist gene polymorphism is associated with severe renal involvement and renal sequelae in Henoch-Schonlein purpura. J Rheumatol. 2002, 29: 1404-1407. Amoli MM: Interleukin 8 gene polymorphism is associated with increased risk of nephritis in cutaneous vasculitis. J Rheumatol. 2002, 29: 2367-2370. Amoli MM: Interleukin 1beta gene polymorphism association with severe renal manifestations and renal sequelae in Henoch-Schonlein purpura. J Rheumatol. 2004, 31: 295-298. Garcia-Porrua C: Predictive factors for renal sequelae in adults with Henoch-Schonlein purpura. J Rheumatol. 2001, 28: 1019-1024. Usui K: Diffuse pulmonary hemorrhage as a fatal complication of Schonlein-Henoch purpura. J Dermatol. 2007, 34: 705-708. 10.1111/j.1346-8138.2007.00364.x Soloukides A: Pulmonary involvement in Henoch-Schonlein purpura. Emerg Med J. 2006, 23: 886. Nadrous HF: Pulmonary involvement in Henoch-Schonlein purpura. Mayo Clin Proc. 2004, 79: 1151-1157. 10.4065/79.9.1151 Mizuashi M: Facial purpura and scrotal swelling: a quiz. Henoch-Schonlein purpura. Acta Derm Venereol. 2009, 89: 549-550. Garzoni L: Nervous system dysfunction in Henoch-Schonlein syndrome: systematic review of the literature. Rheumatology (Oxford). 2009, 48: 1524-1529. 10.1093/rheumatology/kep282. Ohnuma K: An adult case of Henoch-Schonlein purpura complicating common peroneal nerve mononeuropathy. Mod Rheumatol. 2009, 19: 73-79. 10.1007/s10165-008-0121-5 Fielding RE: Seizures complicating adult Henoch-Schonlein purpura. Nephrol Dial Transplant. 1998, 13: 761-762. 10.1093/ndt/13.3.761 Lutz HH: Henoch-Schonlein purpura complicated by cardiac involvement: case report and review of the literature. Am J Kidney Dis. 2009, 54: e9-15. 10.1053/j.ajkd.2009.04.017 Shin JI: Cardiac manifestations of Henoch-Schoenlein purpura: IgA mediated vasculitis or Rheumatic fever?. Eur J Pediatr. 2007, 166: 627. 10.1007/s00431-006-0273-2 Polizzotto MN: Cardiac involvement in Henoch-Schonlein purpura. Intern Med J. 2006, 36: 328-331. 10.1111/j.1445-5994.2006.01061.x Zurada JM, Ward KM, Grossman ME: Henoch-Schonlein purpura associated with malignancy in adults. J Am Acad Dermatol. 2006, 55: S65-S70. 10.1016/j.jaad.2005.10.011 Mills JA: The American College of Rheumatology 1990 criteria for the classification of Henoch-Schonlein purpura. Arthritis Rheum. 1990, 33: 1114-1121. Ozen S: EULAR/PReS endorsed consensus criteria for the classification of childhood vasculitides. Ann Rheum Dis. 2006, 65: 936-941. Kawana S, Nishiyama S: Serum SC5b-9 (terminal complement complex) level, a sensitive indicator of disease activity in patients with Henoch-Schonlein purpura 68. Dermatology. 1992, 184: 171-176. 10.1159/000247535 Pyne D, Mootoo R, Bhanji A: Colchicine for the treatment of recurrent Henoch-Schonlein purpura in an adult. Rheumatology (Oxford). 2001, 40: 1430-1431. 10.1093/rheumatology/40.12.1430. Sarma PS: Dapsone in Henoch-Schonlein purpura. Postgrad Med J. 1994, 70: 464-465. 10.1136/pgmj.70.824.464 Sharma A: Successful treatment of severe gastrointestinal involvement in adult-onset Henoch-Schonlein purpura. Singapore Med J. 2007, 48: 1047-1050. Pillebout E: Addition of cyclophosphamide to steroids provides no benefit compared with steroids alone in treating adult patients with severe Henoch Schonlein Purpura. Kidney Int. 2010, 78: 495-502. 10.1038/ki.2010.150 Rech J: Plasmapheresis therapy in an elderly patient with rapidly progressive Henoch-Schonlein purpura with disseminated organ involvement. Clin Rheumatol. 2007, 26: 112-114. 10.1007/s10067-005-0113-1 Schmaldienst S: Severe nephrotic syndrome in a patient with Schonlein-Henoch purpura: complete remission after cyclosporin A. Nephrol Dial Transplant. 1997, 12: 790-792. 10.1093/ndt/12.4.790 Kusuda A: Successful treatment of adult-onset Henoch-Schonlein purpura nephritis with high-dose immunoglobulins. Intern Med. 1999, 38: 376-379. 10.2169/internalmedicine.38.376 Bayrakci US: Effect of early corticosteroid therapy on development of Henoch-Schonlein nephritis. J Nephrol. 2007, 20: 406-409.