Henoch's Purpura: Small Intestinal Changes

Abstract

Adisease in which there is hemorrhage in the gastro-intestinal tract, frequently associated with skin or joint involvement, has been known as Henoch's purpura, Henoch-Schönlein purpura, anaphylactoid purpura, purpura rheumatica, abdominal purpura, and sometimes as idiopathic purpura. The disease is generally considered to be a non-thromboeyto-penic form of purpura, but in some cases in which abdominal symptoms have predominated there has been, also, a thrombocytopenia (1, 3). When the abdominal symptoms are unassociated with purpuric manifestations elsewhere, or when abdominal symptoms precede the skin and joint changes, the diagnosis may be difficult (2). Appendicitis, intestinal obstruction, intussusception, and ileitis are the conditions generally confused (2, 4) with Henoch's purpura, and either intussusception or obstruction may be associated with it as a complication (7, 9). Althausen, Deamer, and Kerr (1) reported 8 cases of Henoch's purpura and abdominal allergy, in 6 of which 9 operations had been done in various hospitals. In the published reports we have found references to gastro-intestinal x-ray examinations for diagnosis of obstruction and intussusception, but no description or note of any intestinal changes. In view of the pathological process, hemorrhage in the mucosal layer, which would obliterate the normal mucosal folds and in severe cases cause separation of patches of mucosa and ulceration, roentgen examination of the intestinal tract would appear to be a valuable diagnostic aid in doubtful cases. In the case to be reported here there was the appearance of a marked ulcerative or destructive process in the upper jejunum, with loss of the normal pattern in the greater part of the small intestine; there was hypomotility rather than the hypermotility usually found in acute enteritis; and there was dilatation of the upper jejunum, which, associated with the mucosal changes, suggested a chronic ulcerative condition. Re-examination after three weeks showed great improvement in the intestinal pattern, and at the end of six weeks the intestinal pattern and motility were normal. It is realized that any conclusions based on a single example may be misleading, but this case is reported as one of purpura showing extensive small intestinal damage and remarkable repair ability on the part of the small intestine. It is suggested that x-ray studies of the small intestine may differentiate purpura from other conditions in acute abdominal cases when the diagnosis is uncertain. Case Report H. C. A., white male, age 20, was admitted May 1, 1943, complaining of cramping abdominal pain, which had its onset three days before admission and had been of sufficient severity to interfere with sleep. For the past two days he had had frequent loose bowel movements; three stools, on the morning of admission, were said to contain bright red blood.