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.
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.
8 comments:
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Thank you for sharing this.
ReplyDeleteWe described another adult case (31-year-old) of HSP here:
A Young Man with Henoch-Schönlein Purpura
http://clinicalcases.org/2004/07/young-man-with-henoch-schnlein-purpura.html
BUN/Cr were normal.
Thanks for the comment.
ReplyDeleteGreat pics with the case on your blog. My photo was just taken from some random internet page.
Nathan.
I suffered a bout of HSP with symptoms that began one month after my 58th birthday. I am seeking information on any other HSP cases in people over the age of a good whiskey.
ReplyDeleteI had no previous influenza or respiratory problems. The trigger seems to have been my taking eight or ten aspirin tablets for minor pain within the week before the rash showed up on my lower legs. I hadn't taken aspirin in years.
Please see my comments in CLINICAL CASES AND IMAGES.
A year after the fading of my rashes, blisters and open sores my kidneys are fine but my lower legs are discolored and I still suffer from pains in my joints.
I can be emailed at acp.design@yahoo.com
Ok
ReplyDeleteIt's "acp" again.
Does no one read this oh so important renal revelations version of Clue?
I kind of expected a slew of pertinent epistles relating tales of unsuspecting autoimmune sufferers blind-sided by debilitating rashes, blisters, welts and open sores who are left in recovery with arthritic symptoms such joint swelling and pain.
Has anyone got a story to tell?
Please tell it here, or email me at acp.design@yahoo.com
I'm 26 and I am an adult with HSP. And so far nothing has really helped me cope with it once and for all. Any sujjections?
ReplyDeleteI am a 56 year old nurse with HSP who has had it for 23 years following a severe ecoli gastroenteritis. I was well controlled for many years by addressing my food sensitivities. Food is the trigger for my abdominal pain and my joints and when I removed the offending foods, I was over 75% better. I have had a flare up recently and am now on a low dose of Imuran until I can heal again. The low dose is only possible because of the time I take to address the food sensitivities that I have. If anyone would love to hear more of my story you can email me at margaret@dynamicchoices.ca. I also have the story posted on my website at www.dynamicchoices.ca
ReplyDeleteAlso, if anyone is on Imuran or prescribing it, put the drug in an empty capsule before you take it to avoid the horrendous mouth irritation it sometimes creates. It makes a huge difference1!! You can also use the mouthwash that is given to cancer patients to relieve the symptoms.
Hi im a 27 year old male(dublin Ireland), I thought i was the closest thing to invicible, ride out the cold or flu symptoms never worry about sneezing, sure i'll hit the gym and i'll be grand and this formula worked 90% of the time, then out of the blue 30 dec 2009 few spots on my shins,first thought "ah its a small rash from my socks", 3 days on a few spots were now angry red spots covering both my legs, then i started getting very tender joints(knees/ankles/wrists), 2 days before i seen the first spots i had some cold symptoms and I took 2 aspirin tabs, were 1 was advised on the packet, not sure if this was the trigger, but i wont be trying it again to see, 2 months on im back playing football and throwing weights around like there nothing, my kidneys are still not in the clear, have to do a 24 hour urie collection and an ultra sound in 8 weeks post there results a decision will be made if i need a kidney biopsy.my email is warturkey@gmail.com if anybody wants to ask any questions how i dealt with it feel free to mail,
ReplyDeleteI am 42 years old and was just diagnosed with HSP. It started a month ago with really bad rashes and extreme pain in my legs. I spent a week of misery in the hosptial and through a skin and kidney biopsy, was diagnosed. 1 month later, my rashes are healing but I am dealing with a bunch of other issue due to my kindneys not functioning to their fullest. I am extremely swollen over my whole body (gained 60 lbs !), due to my kidneys and the drugs I have to take to help get this disease into remission. I would love to talk to any other adult that has suffered from this aweful disease. you can email me at mojofoodtruck@aol.com
ReplyDelete