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Unexpected outcome (positive or negative) including adverse drug reactions
Henoch–Schönlein purpura: a clinical case with dramatic presentation
  1. João Bento1,
  2. Adriana Magalhães1,
  3. Conceição Souto Moura2,
  4. Venceslau Hespanhol1
  1. 1Department of Pulmonology, Hospital de S Joao, Alameda Professor Hernani Monteiro, Porto, Portugal
  2. 2Department of Pathology, Hospital de S Joao, Alameda Professor Hernani Monteiro, Porto, Portugal
  1. Correspondence to João Bento, joao.a.p.bento{at}gmail.com

Summary

A case study involving a 55-year-old Caucasian male with end-stage glomerulosclerosis is presented here. Kidney biopsies showed no deposits on imunofluorescent microscopy. Relapsing massive haemoptysis and suspected bronchovascular malformation required lung lobectomy which revealed malformative and tortuous small blood vessels, with no vasculitis. Blood antinuclear antibodies, antineutrophil cytoplasmic antibodies and antiglomerular basement membrane antibodies were undetectable. Seric immunoglobulins and complement levels were normal. Three months later, arthralgia and joint oedema first appeared. Skin biopsy revealed vasculitis immune-reactive to immunoglobulin A. Systemic corticotherapy was then started. Two weeks later, the patient presented with abdominal pain melena and rectal bleeding (haematoquesia). Endoscopic study showed diffuse gastrointestinal haemorrhage. Angiographic study revealed diffuse lesions compatible with vasculitis and haemorrhage from multiple spots. Cyclophosphamide and then intravenous immunoglobulin were associated to treatment without response. Increasing blood loss occurred, with massive gastrointestinal haemorrhage and haemorrhagic ascitis. Death occurred due to uncontrolled diffuse bleeding. Necropsy findings showed generalised small vessels vasculitis compatible with Henoch–Schönlein purpura.

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

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