Four Cancers and a Rash: Henoch–Schönlein Purpura

Abstract

A patient who had a history of 4 primary malignancies developed a rash that is usually seen among children. The 65year-old man presented with a 2-day history of anasarca, painless skin lesions, and new arthralgias in both hands. He had a previous diagnosis of amyotrophic dermatomyositis, and although he had none of the typical skin manifestations of that disease on arrival at our institution, he did have associated interstitial lung disease. His medical history also included squamous cell lung cancer and cancers of the rectum, sigmoid colon, and urothelium. Four weeks earlier, he had undergone left nephroureterectomy for stage IV urothelial cancer complicated by postoperative atrial fibrillation and Clostridium difficile colitis. At that time, he was started on amiodarone and metronidazole.

Galactose-Deficient IgA1 Deposits in Clear Cell Renal Cell Carcinoma-Related Henoch–Schönlein Purpura Nephritis

“…e renal manifestations of HSPN can range from microscopic hematuria and proteinuria only to a rapidly progressive glomerulonephritis (RPGN). Of those who undergo a kidney biopsy, 95% show IgA deposition in the mesangial area [12][13][14][15][16][17][18][19][20][21][22]. e most frequent lesion in renal biopsies is proliferative endocapillary glomerular nephritis [11].…”

“…The most frequent lesion in renal biopsies is proliferative endocapillary glomerular nephritis [ 11 ]. The outcome of HSPN in adults is relatively poor, and the most frequent cause of death was neoplasia (up to 27% of death) [ 10 – 12 , 14 , 16 , 18 , 21 ] although significant improvement of renal function was reported in some cases with treatment of the cancer and corticosteroids for HSPN [ 13 – 15 , 22 ]. The independent prognostic factors of renal outcome in patients with HSPN are proteinuria level, initial renal failure, and the histologic quantification of interstitial fibrosis and glomerular sclerosis [ 11 ].…”