Massive gastrointestinal haemorrhage in isolated intestinal Henoch-Schonlein purpura with response to intravenous immunoglobulin infusion

Abstract

There is increasing recognition that Henoch-Schonlein purpura may present in an atypical form in which gastrointestinal symptoms may predominate, and classic cutaneous changes may be delayed or absent. This may lead to significant diagnostic delay. We report the case of a 9-year-old girl who presented acutely with life-threatening gastrointestinal haemorrhage from multiple intestinal sites, with no skin rash and only mild evidence of renal involvement. Henoch-Schonlein purpura was confirmed by finding IgA deposition on vessels within gastric and duodenal mucosa, while immunohistochemistry also identified dense focal T cell infiltration in gastric mucosa and within duodenal epithelium. After initial stabilisation, the patient became shocked due to further gastrointestinal haemorrhage. Isotope bleeding scan identified multiple bleeding sites. Her endoscopically confirmed gastritis was sufficiently severe to preclude corticosteroids, and she was thus treated with intravenous immunoglobulin. This therapy induced prompt and sustained resolution of symptoms, and she has remained well since. Our patient's response concords with previous reports in corticosteroid-resistant cases to suggest that severe intestinal Henoch-Schonlein purpura may respond preferentially to intravenous immunoglobulin (IVIG) therapy. In severe cases where there is significant gastritis, IVIG provides an effective alternative to corticosteroids that may be employed as first-line therapy.

Severe gastrointestinal vasculitis in Henoch-Schoenlein purpura: pathophysiologic mechanisms, the diagnostic value of factor XIII, and therapeutic options

“…We read with great interest the recent contribution by Fagbemi et al in the European Journal of Pediatrics [3]. They reported a 9-year-old girl with an atypical course of Henoch-Schoenlein purpura (HSP).…”

A 10-Year-Old Girl with Gastrointestinal Hemorrhage

“…[18][19][20][21][22][23] Because our patient had severe duodenal bleeding, we at first ruled out the use of steroids and considered using intravenous immunoglobulin, which has been suggested in the literature to be effective. [24][25][26][27][28] However, we changed our minds and decided to use steroids (2 mg/kg of methylprednisolone intravenously) as first-line therapy. Our patient showed complete progressive improvement of her general condition in the first 24 hours of steroid therapy, with complete remission after 3 weeks.…”

The effects of consumption of raw garlic on serum lipid level, blood sugar and a number of effective hormones on lipid and sugar metabolism in hyperglycemic and/or hyperlipidemic individuals ——Benefit of raw garlic consumption

“…Among vegetables, garlic is one of the most important ones [5,6]. Garlic (Allium sativum) is a member of the Liliaceae family, which is one of the most popular herbs used worldwide to reduce various risk factors associated with several diseases [7]. It has been reported that garlic and onions are effective in preventing cardiovascular diseases due to their hypocholesterolemic, hypolipidemic, antihyperten-sive, antidiabetic, antithrombotic and antihyperhomocysteinemia effects [8].…”