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Abstract
Background: Henoch-Schonlein Purpura (HSP), or IgA vasculitis, is the most common vasculitis in children and is characterized by four symptoms: palpable purpura with no concurrent thrombocytopenia or coagulopathy, arthritis/ arthralgias, abdominal pain, and renal disease. HSP does occur in older patients at a much lower frequency. Objective: To discuss the atypical presentation of HSP in an elderly adult and the increased nephrogenic risks that are involved in this patient group. Case Presentation: We present the history, physical findings, laboratory results, and the clinical course of a 74-year-old Caucasian male with an atypical presentation of HSP. Our patient presented with severe gastrointestinal and cutaneous symptoms which occurred after the onset of abdominal pain. Biopsies demonstrated leukocytoclastic vasculitis in the skin and acute inflammation and hemorrhage in the gastrointestinal tract. The diagnosis was confirmed as IgA vasculitis following the renal biopsy. The patient’s symptoms improved with the administration of methylprednisolone. Conclusion: In adults with HSP there is greater concern regarding renal involvement and a greater risk of developing end-stage renal disease compared to children. The importance of recognizing HSP in the elderly is imperative for early diagnosis and appropriate treatment to limit renal damage.
Highlights
Henoch-Schonlein Purpura (HSP) is an immune-mediated vasculitis associated with IgA deposition
Case Presentation: We present the history, physical findings, laboratory results, and the clinical course of a 74-year-old Caucasian male with an atypical presentation of HSP
A retrospective study of 261 patients diagnosed with HSP conducted from December 1991 to December 2001 found that 58% of patients reported abdominal pain [4]
Summary
Henoch-Schonlein Purpura (HSP) is an immune-mediated vasculitis associated with IgA deposition. A retrospective review of HSP cases in France found that 48% of patients presented with gastrointestinal symptoms [5]. Gastrointestinal symptoms occur in up to 50% of children with HSP and typically develop within eight days after the appearance of the rash. Renal involvement is more prevalent in older children and adults [7], with the most common finding being hematuria. Henoch-Schonlein Purpura (HSP), or IgA vasculitis, is the most common vasculitis in children and is characterized by four symptoms: palpable purpura with no concurrent thrombocytopenia or coagulopathy, arthritis/ arthralgias, abdominal pain, and renal disease. Objective: To discuss the atypical presentation of HSP in an elderly adult and the increased nephrogenic risks that are involved in this patient group. Our patient presented with severe gastrointestinal and cutaneous symptoms which occurred after the onset of abdominal pain. The importance of recognizing HSP in the elderly is imperative for early diagnosis and appropriate treatment to limit renal damage
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