J Korean Rheum Assoc.  2007 Jun;14(2):171-175. 10.4078/jkra.2007.14.2.171.

A Case of Henoch-Schonlein Purpura in a Patient withRheumatoid Arthritis and Chronic Lymphocytic Thyroiditis

• Kim S
• Chung JR
• Kang EH
• Im CH
• Lee EY
• Lee YJ
• Song YW

• KMID: 1526436
• DOI: http://doi.org/10.4078/jkra.2007.14.2.171

Abstract

Henoch-Schonlein purpura (HSP) is a small-vessel vasculitis involving skin, gut, and kidney associated with arthralgia, arthritis and characterized by immunoglobulin A (IgA)-dominant immune deposits in target organs. This vasculitis is common in children and rarely reported to be associated with other autoimmune disease such as rheumatoid arthritis, autoimmune thyroiditis. We report the case of 72 year-old man who developed adult-onset HSP and also had rheumatoid arthritis and chronic lymphocytic thyroiditis. This is the first report in South Korea.

Keyword

Henoch-Schonlein purpura; Rheumatoid arthritis; Thyroiditis

MeSH Terms

Aged
Arthralgia
Arthritis*
Arthritis, Rheumatoid
Autoimmune Diseases
Child
Hashimoto Disease*
Humans
Immunoglobulin A
Kidney
Korea
Purpura, Schoenlein-Henoch*
Skin
Thyroiditis
Thyroiditis, Autoimmune
Vasculitis
Immunoglobulin A

Figure

• 

  Fig. 1. Purpura in both lower legs.

• 

  Fig. 2. Hand X-ray shows periarticular osteopenia in both hands and marginal erosion adjacent to the right 4th proximal interphalangeal joint.

• 

  Fig. 3. Kidney biopsy demonstrating diffuse proliferative glomerulonephritis with crescent formation (H&E, x 200).

• 

  Fig. 4. The fluorescence microscopic examination shows mesangial and peripheral staining of IgA (IF, x200).

Reference

1). Saulsbury FT. Henoch-Schonlein purpura. Curr Opin Rheumatol. 2001. 13:35–40.

2). Ballinger S. Henoch-Schonlein purpura. Curr Opin Rheumatol. 2003. 15:591–4.

3). Saulsbury FT. Heavy and light chain composition of serum IgA and IgA rheumatoid factor in Henoch-Schonlein purpura. Arthritis Rheum. 1992. 35:1377–80.

4). Mitsuhashi H., Mitsuhashi M., Tsukada Y., Yano S., Naruse T. Henoch-Schonlein purpura in rheumatoid arthritis. J Rheumatol. 1994. 21:1138–40.

5). Cho CS., Min JK., Park HS., Yang HI., Lee SH., Choi YJ, et al. Protein losing enteropathy associated with Henoch-Schonlein purpura in a patient with rheumatoid arthritis. Scand J Rheumatol. 1996. 25:334–6.

6). Garcia-Porrua C., Gonzalez-Gay MA., Botana M., Sanchez-Andrade A. Henoch-Schonlein purpura in adults and autoimmune thyroiditis. J Rheumatol. 2000. 27:1326–7.

7). Kwon EH., Kim SJ., Na MA., Jung YS., Lee DW., Lee SB, et al. A clinicopathological study of the adult Henoch-Schonlein purpura. Korean J Med. 2003. 65:323–34.

8). Pillebout E., Thervet E., Hill G., Alberti C., Vanhille P., Nochy D. Henoch-Schonlein purpura in adults: outcome and prosnostic factors. J Am Soc Nephrol. 2002. 13:1271–8.

9). Nishiya K., ᄋosaki F., Nakamura T., Hashimoto K., Kariya K., Seike M, et al. Rheumatoid arthritis associated with Henoch-Schonlein purpura. Clin Exp Rheumatol. 2000. 18:653–4.

10). Mills JA., Michel BA., Bloch DA., Calabrese LH., Hunder GG., Arend WP, et al. The American College of Rheumatology 1990 criteria for the classification of Henoch-Schonlein purpura. Arthritis Rheum. 1990. 33:1114–21.