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High-dose methylprednisolone pulse therapy for treatment of refractory intestinal involvement caused by Henoch-Schönlein purpura: a case report.

Kang HS, Chung HS, Kang KS, Han KH - J Med Case Rep (2015)

Bottom Line: Henoch-Schönlein purpura was diagnosed based on endoscopic findings of hemorrhagic duodenitis and duodenal vasculitis and abdominal computed tomography findings of edematous bowels.Subsequently, we used high-dose intravenous methylprednisolone pulse therapy (30 mg/kg/day, with a maximum of 1g/day), which dramatically alleviated her abdominal symptoms.High-dose intravenous methylprednisolone pulse therapy can be used as the ultimate treatment for delayed-onset Henoch-Schönlein purpura with severe abdominal pain when symptoms do not improve after low-dose steroid and intravenous immunoglobulin treatments.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Jeju National University Hospital, Aran 13gil 15, Jeju-si, Jeju Special Self-Governing Province, 690-767, Korea. medyapsb@naver.com.

ABSTRACT

Introduction: Henoch-Schönlein purpura is an immunoglobulin A-mediated, small vascular inflammatory disease that can be associated with palpable purpura, arthralgia, abdominal pain, or nephritis. The presence of purpura facilitates the diagnosis of Henoch-Schönlein purpura at the onset of associated symptoms, whereas the absence of purpura makes the diagnosis challenging. It is important to diagnose Henoch-Schönlein purpura with delayed-onset skin purpura to avoid unnecessary surgery for acute abdomen. Most cases of Henoch-Schönlein purpura with severe abdominal pain are treated with low-dose steroids and intravenous immunoglobulin.

Case presentation: A 15-year-old Korean girl complained of severe abdominal pain and delayed-onset purpura on admission. Henoch-Schönlein purpura was diagnosed based on endoscopic findings of hemorrhagic duodenitis and duodenal vasculitis and abdominal computed tomography findings of edematous bowels. Two common initial treatments, a low-dose steroid and intravenous immunoglobulin, were administered, but there was no improvement for 1 month. Subsequently, we used high-dose intravenous methylprednisolone pulse therapy (30 mg/kg/day, with a maximum of 1g/day), which dramatically alleviated her abdominal symptoms.

Conclusions: High-dose intravenous methylprednisolone pulse therapy can be used as the ultimate treatment for delayed-onset Henoch-Schönlein purpura with severe abdominal pain when symptoms do not improve after low-dose steroid and intravenous immunoglobulin treatments.

No MeSH data available.


Related in: MedlinePlus

Computed tomography of the abdomen showing an edematous bowel. This image shows multifocal areas of bowel wall thickening, mesenteric edema, and vascular engorgement in jejuno-ileal loops (yellow arrows).
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Fig2: Computed tomography of the abdomen showing an edematous bowel. This image shows multifocal areas of bowel wall thickening, mesenteric edema, and vascular engorgement in jejuno-ileal loops (yellow arrows).

Mentions: On HD 7, she experienced dyspnea and persistent abdominal pain. She had an acutely ill appearance. Her BP and temperature increased to 140/80mmHg and 38.3°C, respectively. Her serum was negative for antinuclear antibody and anti-neutrophil cytoplasmic antibody. Serum complements 3 and 4 (132mg/dL and 16mg/dL, respectively) were within normal limits. Serum IgG, IgA, and IgM levels were 3629mg/dL (normal range, 639 to 1349mg/dL), 162mg/dL (normal range, 70 to 312mg/dL), and 139mg/dL (normal range, 56 to 352mg/dL), respectively. Urine analysis revealed microscopic hematuria. An abdominal computed tomography (CT) scan showed an edematous bowel (Figure 2). Intravenous cefotaxime was added because of her persistent high fever and inflammation. IMPT (60mg/day) was discontinued because of pancreatitis.Figure 2


High-dose methylprednisolone pulse therapy for treatment of refractory intestinal involvement caused by Henoch-Schönlein purpura: a case report.

Kang HS, Chung HS, Kang KS, Han KH - J Med Case Rep (2015)

Computed tomography of the abdomen showing an edematous bowel. This image shows multifocal areas of bowel wall thickening, mesenteric edema, and vascular engorgement in jejuno-ileal loops (yellow arrows).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4378549&req=5

Fig2: Computed tomography of the abdomen showing an edematous bowel. This image shows multifocal areas of bowel wall thickening, mesenteric edema, and vascular engorgement in jejuno-ileal loops (yellow arrows).
Mentions: On HD 7, she experienced dyspnea and persistent abdominal pain. She had an acutely ill appearance. Her BP and temperature increased to 140/80mmHg and 38.3°C, respectively. Her serum was negative for antinuclear antibody and anti-neutrophil cytoplasmic antibody. Serum complements 3 and 4 (132mg/dL and 16mg/dL, respectively) were within normal limits. Serum IgG, IgA, and IgM levels were 3629mg/dL (normal range, 639 to 1349mg/dL), 162mg/dL (normal range, 70 to 312mg/dL), and 139mg/dL (normal range, 56 to 352mg/dL), respectively. Urine analysis revealed microscopic hematuria. An abdominal computed tomography (CT) scan showed an edematous bowel (Figure 2). Intravenous cefotaxime was added because of her persistent high fever and inflammation. IMPT (60mg/day) was discontinued because of pancreatitis.Figure 2

Bottom Line: Henoch-Schönlein purpura was diagnosed based on endoscopic findings of hemorrhagic duodenitis and duodenal vasculitis and abdominal computed tomography findings of edematous bowels.Subsequently, we used high-dose intravenous methylprednisolone pulse therapy (30 mg/kg/day, with a maximum of 1g/day), which dramatically alleviated her abdominal symptoms.High-dose intravenous methylprednisolone pulse therapy can be used as the ultimate treatment for delayed-onset Henoch-Schönlein purpura with severe abdominal pain when symptoms do not improve after low-dose steroid and intravenous immunoglobulin treatments.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Jeju National University Hospital, Aran 13gil 15, Jeju-si, Jeju Special Self-Governing Province, 690-767, Korea. medyapsb@naver.com.

ABSTRACT

Introduction: Henoch-Schönlein purpura is an immunoglobulin A-mediated, small vascular inflammatory disease that can be associated with palpable purpura, arthralgia, abdominal pain, or nephritis. The presence of purpura facilitates the diagnosis of Henoch-Schönlein purpura at the onset of associated symptoms, whereas the absence of purpura makes the diagnosis challenging. It is important to diagnose Henoch-Schönlein purpura with delayed-onset skin purpura to avoid unnecessary surgery for acute abdomen. Most cases of Henoch-Schönlein purpura with severe abdominal pain are treated with low-dose steroids and intravenous immunoglobulin.

Case presentation: A 15-year-old Korean girl complained of severe abdominal pain and delayed-onset purpura on admission. Henoch-Schönlein purpura was diagnosed based on endoscopic findings of hemorrhagic duodenitis and duodenal vasculitis and abdominal computed tomography findings of edematous bowels. Two common initial treatments, a low-dose steroid and intravenous immunoglobulin, were administered, but there was no improvement for 1 month. Subsequently, we used high-dose intravenous methylprednisolone pulse therapy (30 mg/kg/day, with a maximum of 1g/day), which dramatically alleviated her abdominal symptoms.

Conclusions: High-dose intravenous methylprednisolone pulse therapy can be used as the ultimate treatment for delayed-onset Henoch-Schönlein purpura with severe abdominal pain when symptoms do not improve after low-dose steroid and intravenous immunoglobulin treatments.

No MeSH data available.


Related in: MedlinePlus