Henoch-Schönlein Purpura and Retroperitoneal Fibrosis

N. Akman, Y. Avanoğlu, K. Karabay, E. Erek, A. Tokgöz, E. Aras, G. Girişken, N. Tüzüner, H. Avanoğlu, Departments of Internal Medicine, Urology and Pathology, Medical School of Cerrahpaşa, University of Istanbul, Istanbul (Turkey) To the Editor, A relationship between Henoch-Schönlein purpura and retroperitoneal fibrosis has not yet been published. Case History A 17-year-old boy from Istanbul was hospitalized in February 1980 with the chief complaints of purpu-ric rash, abdominal pain associated with nausea, and swelling of the knees and ankles for 15 days. He had a history of an upper respiratory tract infection 2 weeks before onset. He had used analgesics only. On physical examination, no pathologic findings were present in the all systems except for purpuric rashes on the lower legs and periarticular swelling of the knees and the ankles. On admission, his sedimentation rate, his biochemical tests and his hematological findings including hemostatic tests were within the normal limits. The antistreptolysin 0 titre was 833 Todd Units. Latex test, LE cell and cyroglobulin were negative. Staphylococcus aureus was isolated from the throat. Urinalysis revealed trace protein-uria, 1–2 white blood cells, 25–30 red blood cells and a few casts per high power field. Urine culture failed to yield growth of bacterial organisms. Glomerular filtration rate was 120 ml/min. 50 mg of parenteral prednisone was given to the patient daily for 6 weeks and 2 g of parenteral D-aminobenzylpenicillin was used daily for 2 weeks. Abdominal and articular manifestations persisted until April, 1980. Microscopic hematuria and trace proteinuria were still present in the urine examination after regression of these manifestations. An intravenous pyelogram obtained in April 1980 revealed right ureteropelvic stenosis and hydronephrosis, and in July 1980 repeated intravenous pyelogram demonstrated bilateral ureteropelvic stenosis. In July 1980 the patient was operated on the left side. Fibrous tissue was observed around the ureter above the iliac bifurcation. Left ureterolysis and left ureteroplastic dilatation were done and the ureter was transplantated within the peritoneal cavity and ureterostomy was performed. In August 1980, he was operated on the right side. On