A case of Henoch-Schonlein purpura with fatal pulmonary haemorrhage and capillaritis is described.Henoch-Schonlein purpura is a syndrome characterised by a rash, arthritis, gastrointestinal manifestations, and nephritis secondary to diffuse necrotising vasculitis. Clinically evident pulmonary disease is very rare and most reports on series of patients do not mention it. We report a patient with fatal intrapulmonary haemorrhage and briefly review the relevant publications.Case report A 78 year old man was admitted with a one day history of passing dark red blood rectally. Three weeks previously he had been investigated elsewhere for weight loss, arthralgia, and haemoptysis. Chest radiography had shown patchy opacities in both lower lobes. Blood urea and creatinine concentrations were normal. Sputum culture had been negative, and bronchoscopy had showed an inflamed mucosa. He was treated with penicillin on the presumptive diagnosis of bacterial pneumonia and the haemoptysis had resolved.On admission he was shocked, and there was a purpuric rash on the buttocks and lower trunk. The blood urea was 50 mmol/l, potassium 7-4 mol/l, and haemoglobin 16-5 g/dl; the platelet count was normal. Clotting studies showed a prothrombin time of25 (control 10-14) seconds and an activated partial thromboplastin time of 52 (control 30-45) seconds. A chest radiograph was normal.The patient's condition improved rapidly after resuscitation with intravenous fluids, and the potassium concentration fell to normal values, though the urea remained raised. Oesophagogastroscopy showed haemorrhagic ulcerated oesophagitis. Vitamin K was given and clotting studies gave normal results by the next day.He remained clinically stable until the third day after admission, when, over minutes, he became acutely dyspnoeic. Chest examination revealed right basal crepitations. Antibiotics were started, but over the next hour he became increasingly breathless and died.At necropsy the lungs were heavy, oedematous, and congested. Microscopically there was extensive intraAddress for reprint requests:

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Conclusions:The ALBI score is a significant predictor of mortality after TIPS creation. However, the MELD score remains the superior predictor of mortality after TIPS.