Terminal Ileitis: A Rare Complication of Henoch-Schönlein Purpura in Children

Abstract

Henoch–Schönlein purpura (HSP) is characterized by nonthrombocytopenic palpable purpura, arthritis or arthral­gia, and gastrointestinal and/or renal involvement. Gastrointestinal symptoms are reported in 50%-75% and they are related to a previous group A streptococcal infection in 40%. A healthy 5-year-old girl presented with a three-week history of a recurrent purpuric rash on the lower limbs, ar­thralgia and angioedema, without renal involvement. During the third relapse, she had severe, diffuse and persistent abdominal pain and bloody stools. An abdominal ultrasound revealed transmural edema of the last ileal segment, compatible with ileitis. She received prednisolone for five days, with full clinical recovery. Antistreptolysin O titer was elevated. The remaining laboratory tests were normal (antinuclear, anti-neutrophil and anti-Saccharomyces cerevisiae antibodies; rheumatoid factor; stool cultures, parasitological examination and viral antigen tests). One month later, an abdominal ultrasound revealed no abnormalities. Terminal ileitis is a very rare complication of HSP in children but has a good prognosis.

Terminal ileitis: a rare gastrointestinal manifestation of IgA vasculitis in a child

“…The aetiology of IgA vasculitis includes vaccinations, infections, drugs, tumours, alpha 1 antitrypsin deficiency and familial Mediterranean fever 2 9. A previous group A streptococcal infection is seen in up to 40% of cases of IgA vasculitis 10. In our case, it is likely the streptococcal throat infection played a role in triggering the antigen-antibody (IgA and C3 containing) complexes and activating the alternate complement pathway leading to inflammation 2.…”

“…Given the short duration of NSAID use, it is unlikely this was the cause of ulcers in her small bowel. Terminal ileitis has been associated with infections including Yersinia , Campylobacter and Salmonella , but stool for culture, parasite and virology was negative, hence ruling this out 9 10…”

“…Ileitis is a rare complication of IgA vasculitis, and only four paediatric cases have previously been reported 6 10 12. In two cases, the children presented with an acute abdomen raising suspicion of acute appendicitis and underwent laparotomy for suspected appendicitis 6.…”