Thursday, February 26, 2009
Interesting Case of Adult Henoch-Schonlein Purpura
Saw a case in the clinic today of a 40-ish year old woman who was diagnosed about a year and a half ago with Henoch-Schonlein purpura. This is notable in that usually this is a pediatric disease--though as this case illustrates it can certainly affect adults. This particular patient had all three elements of the "classic triad" of HSP: purpuric rash, abdominal pain, and arthritis. In addition, she also experienced renal failure secondary to glomerulonephritis, with a creatinine that had elevated to 2.5mg/dL from a normal baseline and whopping proteinuria with a urine protein:creatinine ratio of >20. Fortunately, with plasma exchange, prednisone, and Cytoxan, her symptoms eventually resolved, and today in the clinic (about 1.5 years after having been initially diagnosed) her creatinine was down to 1.2 mg/dL. The disease appears to lie along the same spectrum as IgA Nephropathy, as renal biopsy of HSP patients is often indistinguishable from that of IgA Nephropathy kidneys: mesangial proliferation with IgA deposits. HSP is best categorized as a vasculitis and it is commonly preceded by an upper respiratory tract infection--it has been linked to Strep infection, viral infection, and even certain medications, though in most cases no underlying etiology causing HSP is identified.