Rapidly Progressive Glomerulonephritis in Association with Henoch-Schönlein Purpura in a Patient with Advanced Liver Cirrhosis

Makoto Ogawa, MD, First Department of Internal Medicine, Chiba University School of Medicine, 1-8-1 Inohana Chuouku No. 260, Chiba (Japan) Dear Sir, Secondary IgA nephropathy is a common complication of liver cirrhosis (LC) [1, 2]. However, it seldom takes a rapidly progressive course [1]. Herewith we report a case of LC with Henoch-Schönlein purpura (HPS) and crescentic glomerulonephritis with mes-angial IgA deposits. A 56-year-old man with LC was admitted in December 1993. He had been followed up since 1989, when the diagnosis of LC was confirmed by biopsy. He was positive for hepatitis C virus (HCV) antibody. His uri-nalysis revealed mild haematuria, but serum creatinine concentration was normal. 1 week before admission, he suddenly developed massive haematuria and purpura in his leg following acute respiratory tract infection. Physical examination on admission revealed icteric conjuntivae, abdominal distension, and non-tender purpuric macules of his trunk and extremities (ñg. 1). The laboratory examination revealed haemoglobin 95 g/l, white blood cells 6.5 × 109/1, platelets 88 × 109/1, birilubin 36 μmol/l (2.1 mg/dl), alanine aminotransferase 88 IU/1, serum creatinine 344 μmol/l (3.9 mg/dl), serum albumin 26 g/l, and prothrombin time 14.4 s. Urinalysis showed 150 red blood cells per high-power field, and the urine protein level was 2.6 g/day. Anti-HCV antibody was positive, but serological examination was negative for hepatitis B surface antigen, hepatitis B core antigen antibody, antiglomerular basement membrane antibody, antimito-chondrial antibody, anti-DNA antibody, and antineutrophil cytoplasmic antibody. The serum C3 level was 0.35 (normal 0.5Fig. 1. HSP of the trunk. The abdomen was distended due to ascites. tion showed that half of the glomeruli had cellular or fibrocellular crescents with mes-angial change (fig. 2). Granular deposits of IgA and C3 in the mesangial area were also confirmed. The vascular change was minimal. Cutaneous vasculitis in LC has often been associated with HSP [3, 4] and mixed cryoglobulinaemia [5, 6]. In this case, leuco-clastic vasculitis with IgA deposits seems compatible with HSP, and cryoglobulin testing was negative. The glomerular changes might