RT Journal Article
SR Electronic
T1 Adult Henolch-Schonlein purpura: multiorgan failure in the setting of a purpuric rash
JF BMJ Case Reports
FD BMJ Publishing Group Ltd
SP bcr-2018-224816
DO 10.1136/bcr-2018-224816
VO 2018
A1 Luke Maxfield
A1 Aurora Peck
A1 Laura Bond Youngblood
YR 2018
UL http://casereports.bmj.com/content/2018/bcr-2018-224816.abstract
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.