The Reply

Abstract

We thank Thongprayoon et al1Thongprayoon C. Cheungpasitporn W. Srivali N. Ungprasert P. Coexistence of Henoch-Schönlein purpura and infective endocarditis in elderly.Am J Med. 2015; 128: e17Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar for their letter, “Coexistence of Henoch-Schönlein Purpura and Infective Endocarditis in Elderly,” that was published in response to our publication.2Lavie G. Henig O. Weber G. Zlotnick A.Y. Cohen S. Afebrile endocarditis presenting as purpura and acute renal failure.Am J Med. 2015; 128: e1-e3Abstract Full Text Full Text PDF Scopus (6) Google ScholarThe diagnosis of Henoch-Schönlein purpura typically is based on the clinical presentation. Confirmation of the diagnosis requires evidence of tissue deposition in the skin or kidney of immunoglobulin-A by immunofluorescence microscopy. A kidney biopsy can be performed to establish the diagnosis, but generally this invasive procedure is reserved for patients in whom the diagnosis is uncertain or who have more severe renal involvement.To our knowledge, the rare association of Henoch-Schönlein purpura with infective endocarditis in adults has been described in 4 cases in the literature.3Montoliu J. Miró J.M. Campistol J.M. et al.Henoch Schönlein purpura complicating staphylococcal endocarditis in a heroin addict.Am J Nephrol. 1987; 7: 137-139Crossref PubMed Scopus (37) Google Scholar, 4Galaria N.A. Lopressti N.P. Magro C.M. Henoch Schonlein purpura secondary to subacute bacterial endocarditis.Cutis. 2002; 69: 269-273PubMed Google Scholar, 5Nagayama Y. Iwasaki S. Yamaguchi H. Yoshimura A. Infective endocarditis successfully treated by early medical therapy in a patient with Henoch-Schönlein purpura nephritis under oral steroid therapy.Nihon Jinzo Gakkai Shi. 2007; 49: 452-458PubMed Google Scholar, 6Berquist J.B. Bartels C.M. Rare association of Henoch-Schönlein purpura with recurrent endocarditis.WMJ. 2011; 110: 38-40PubMed Google ScholarDuring our patient's hospitalization, as described in our case report, Henoch-Schönlein purpura was the working diagnosis, and a kidney biopsy was planned after the inconclusiveness of his skin biopsy. Nevertheless, the subsequent endocarditis diagnosis, which could have explained all of our patient's clinical and laboratory findings, guided our further evaluation and treatment. We agree that this rare association should be kept in mind, especially when Henoch-Schönlein purpura diagnosis can lead to potential therapeutic implications. We thank Thongprayoon et al1Thongprayoon C. Cheungpasitporn W. Srivali N. Ungprasert P. Coexistence of Henoch-Schönlein purpura and infective endocarditis in elderly.Am J Med. 2015; 128: e17Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar for their letter, “Coexistence of Henoch-Schönlein Purpura and Infective Endocarditis in Elderly,” that was published in response to our publication.2Lavie G. Henig O. Weber G. Zlotnick A.Y. Cohen S. Afebrile endocarditis presenting as purpura and acute renal failure.Am J Med. 2015; 128: e1-e3Abstract Full Text Full Text PDF Scopus (6) Google Scholar The diagnosis of Henoch-Schönlein purpura typically is based on the clinical presentation. Confirmation of the diagnosis requires evidence of tissue deposition in the skin or kidney of immunoglobulin-A by immunofluorescence microscopy. A kidney biopsy can be performed to establish the diagnosis, but generally this invasive procedure is reserved for patients in whom the diagnosis is uncertain or who have more severe renal involvement. To our knowledge, the rare association of Henoch-Schönlein purpura with infective endocarditis in adults has been described in 4 cases in the literature.3Montoliu J. Miró J.M. Campistol J.M. et al.Henoch Schönlein purpura complicating staphylococcal endocarditis in a heroin addict.Am J Nephrol. 1987; 7: 137-139Crossref PubMed Scopus (37) Google Scholar, 4Galaria N.A. Lopressti N.P. Magro C.M. Henoch Schonlein purpura secondary to subacute bacterial endocarditis.Cutis. 2002; 69: 269-273PubMed Google Scholar, 5Nagayama Y. Iwasaki S. Yamaguchi H. Yoshimura A. Infective endocarditis successfully treated by early medical therapy in a patient with Henoch-Schönlein purpura nephritis under oral steroid therapy.Nihon Jinzo Gakkai Shi. 2007; 49: 452-458PubMed Google Scholar, 6Berquist J.B. Bartels C.M. Rare association of Henoch-Schönlein purpura with recurrent endocarditis.WMJ. 2011; 110: 38-40PubMed Google Scholar During our patient's hospitalization, as described in our case report, Henoch-Schönlein purpura was the working diagnosis, and a kidney biopsy was planned after the inconclusiveness of his skin biopsy. Nevertheless, the subsequent endocarditis diagnosis, which could have explained all of our patient's clinical and laboratory findings, guided our further evaluation and treatment. We agree that this rare association should be kept in mind, especially when Henoch-Schönlein purpura diagnosis can lead to potential therapeutic implications. Coexistence of Henoch-Schönlein Purpura and Infective Endocarditis in ElderlyThe American Journal of MedicineVol. 128Issue 5PreviewWe thank Lavie et al1 for their interesting case study, “Afebrile Endocarditis Presenting as Purpura and Acute Renal Failure,” published in The American Journal of Medicine. Full-Text PDF