Open AccessHenoch-Schönlein purpura from vasculitis to intestinal perforation: A case report and literature review
Author(s) -
Butsabong Lerkvaleekul,
Suporn Treepongkaruna,
Pawaree Saisawat,
Pornsri Thanachatchairattana,
Napat Angkathunyakul,
Nichanan Ruangwattanapaisarn,
Soamarat Vilaiyuk
Publication year - 2016
Publication title -
world journal of gastroenterology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.427
H-Index - 155
eISSN - 2219-2840
pISSN - 1007-9327
DOI - 10.3748/wjg.v22.i26.6089
Subject(s) - medicine , perforation , exploratory laparotomy , vasculitis , abdominal pain , hematochezia , henoch schonlein purpura , purpura (gastropod) , surgery , gastroenterology , radiology , colonoscopy , disease , ecology , materials science , colorectal cancer , cancer , biology , punching , metallurgy
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.