A case of vasculitic cholecystitis associated with Schönlein-Henoch Purpura in an adult

Abstract

A case of Schönlein-Henoch Purpura (SHP) in a 32 year-old female, showing gastrointestinal manifestations including acute vasculitic cholecystitis was reported. In the course of hospitalization urgent laparotomy was performed because of the severe abdominal pain. The gallbladder was inflamed with a brownish-red edematous wall and subserosal hemorrhage, and was resected. Histological examination of the resected gallbladder specimen revealed leucocytoclastic vasculitis. The patient was treated with prednisolone postoperatively, and symptoms abated over two weeks. Acute cholecystitis with SHP is extremely rare, and as far as the authors know this is the second case of this disorder documented by histological examination. Patients with acute abdomen associated with SHP should be managed with consideration of the complications of acute cholecystitis.

Gallbladder Involvement of Henoch-Schönlein Purpura Mimicking Acute Acalculous Cholecystitis

“…Particularly, sonographic characteristics of cholecystitis were found by several investigators, similar to our patient [10,11]. However, there are only two previous reports of histologically proven HSP gallbladder vasculitis in the literature [2,3]. In contrast to our patient these patients had initially both typical purpura as well as acute cholecystitis.…”

“…To our knowledge, this is the first report of HSP presenting as acute cholecystitis in the English literature. However, 2 previous patients have been described who developed histologically proven vasculitic cholecystitis while already having HSP [2,3]. Colicky right upper quadrant pains can therefore rarely be caused by vasculitis, i.e.…”

Single-organ gallbladder vasculitis: Characterization and distinction from systemic vasculitis involving the gallbladder. An analysis of 57 patients

“…Six patients were identified by the Cleveland Clinic database search and 55 patients from the PubMed search. Originally, 83 cases were identified as GV in the literature; however, 28 patients were excluded: 15 patients from a single study, 6 1 patient with IgA vasculitis (Henoch-Schönlein), 35 and 4 with Kawasaki disease 13 did not have sufficient data and 8 cases classified as GB-SOV in whom inadequate follow-up 3,29,38,44,54 or an initial treatment with glucocorticoids and/or cytotoxic agents 33,42 could not guarantee the extent of GV. In addition, 3 patients previously diagnosed with autoimmune diseases (1 each with systemic lupus erythematosus [SLE], 42 rheumatoid arthritis [RA], 42 and mixed connective tissue disease 33 ) did not have involvement of other tissues at the time of GV diagnosis.…”

“…41,53,64 In addition, GV has been observed in fewer than 2% of patients with other SV. 46 Occasionally, GV manifesting as acalculous cholecystitis and GB hydrops has been described associated with IgA vasculitis (Henoch-Schönlein) 23,28,35 and Kawasaki disease. 13 SV or SOV may also exist in many other organs such as the aorta, 52 breast, 26 gynecologic organs, 27 and testicular structures.…”

Gastrointestinal Manifestations of Henoch-Schonlein Purpura

“…LCV involving the gallbladder may cause acute acalculous cholecystitis [95,96] as well as marked thickening of the gallbladder wall [97]. Hydrops of the gallbladder has been described with spontaneous resolution [98].…”