3713 SKIN BIOPSY IN APURPURIC AND PREPURPURIC HENOCHSCHONLEIN PURPURA

Autor: Babu C. Bangaru, Robert S. Schacht, Gail Gallo
Rok vydání: 2000
Předmět:
Zdroj: Gastrointestinal Endoscopy. 51:AB134
ISSN: 0016-5107
DOI: 10.1016/s0016-5107(00)14287-7
Popis: Gastrointestinal (GI) manifestations can be severe in patients with HSP requiring steroids and sometimes plasmapheresis. 3-8% of children with HSP present without the characteristic rash but may have severe GI manifestations, making the diagnosis of HSP difficult. The radiologic and endoscopic findings are non specific. We describe 3 such patients, in whom the diagnosis of HSP was established by biopsy of the seemingly normal skin. In all cases the characteristic leukocytoclastic vasculitis with IgA deposits was found. The microscopic involvement of "normal" skin was not previously described in patients with HSP prior to the appearance of the rash. Patient 1: 7 year old girl presented with acute abdomen; laparotomy diagnosis was mesenteric adenitis. Progressive abdominal distension, ascites, and persistent fever lead to second laparotomy 10 days later. Congested small intestine with focal hemorrhages was found. Subsequent course was characterised by rectal bleeding, hypertension, nephritis and hematemesis. Endoscopy showed antral ulcer with hemorrhagis gastritis and duodenitis. Skin biopsy done one weeek later was diagnostic. Renal biopsy showed IgA nephropathy. Four weeks later, scanty purpuric rash appeared on the right arm and back. Patient 2: 6 year old boy presented with 10 day history of abdominal pains and bilious vomitings. Developed scrotal swelling and surgery showed epididymitis. Hematemesis, tender abdomen and high blood pressure were noted. Endoscopy showed hemorrhagic duodenitis and focal gastritis. Skin biopsy was diagnostic. He never developed purpuric rash. Patient 3: 6 year old boy presented with clinical appendicitis; laparotomy revealed congested terminal ileum. Post operative course was complicated by persistent abdominal pains, hematemesis, and rectal bleeding. Endoscopy showed hemorrhagic gastritis and colitis. Skin biopsy was diagnostic. He developed purpuric rash 2 days after biopsy. Other features of HSP included nephrotic syndrome, high blood pressure, and epididymo-orchitis. Renal biopsy showed IgA nephropathy. Random skin biopsy can be diagnostic in patients with HSP even when the characteristic rash is absent. This may lead to definitive diagnosis and treatment, precluding surgery and reducing morbidity in some cases. Increased use of skin biopsy and therefore increased recognition of atypical presentations of HSP may lead to redefinition of this syndrome.
Databáze: OpenAIRE
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