PT  - JOURNAL ARTICLE
AU  - Luke Maxfield
AU  - Aurora Peck
AU  - Laura Bond Youngblood
TI  - Adult Henolch-Schonlein purpura: multiorgan failure in the setting of a purpuric rash
AID  - 10.1136/bcr-2018-224816
DP  - 2018 Aug 09
TA  - BMJ Case Reports
PG  - bcr-2018-224816
VI  - 2018
4099  - http://casereports.bmj.com/content/2018/bcr-2018-224816.short
4100  - http://casereports.bmj.com/content/2018/bcr-2018-224816.full
AB  - We report a 66-year-old man with a history of congestive heart failure, atrial fibrillation on warfarin therapy and chronic kidney disease that presented with acute dyspnoea. He had multiple palpable purpuric lesions on his bilateral lower extremities. Laboratory findings supported acute anaemia with no obvious bleeding source, supratherapeutic international normalised ratio and acute on chronic kidney injury. Oesophogastroduodenoscopy and colonoscopy initially suggested ischaemic colitis. The patient’s legs were treated symptomatically with topical steroids. He later developed acute large volume bloody diarrhoea that made him haemodynamically unstable. Punch biopsy of the skin was consistent with leucocytoclastic vasculitis and direct immunofluorescence demonstrated immunoglobulin A and C3 deposits consistent with Henoch-Schonlein purpura. The patient was treated with oral steroids. Bleeding stabilised and rash resolved. Steroids were successfully tapered. The patient was discharged on haemodialysis but ultimately this was able to be discontinued.