Korean J Pediatr.  2006 Jul;49(7):784-789. 10.3345/kjp.2006.49.7.784.

Intravenous immunoglobulin for severe gastrointestinal manifestation of Henoch-Schonlein purpura refractory to corticosteroid therapy

• Yang HR
• Choi WJ
• Ko JS
• Seo JK

• KMID: 2140893
• DOI: http://doi.org/10.3345/kjp.2006.49.7.784

Abstract

PURPOSE: Henoch-Schonlein purpura(HSP) is a systemic vasculitis involving small vessels of skin, gastrointestinal(GI) tract and kidney. Digestive involvement of HSP can be serious with massive GI bleeding, perforation, and intussusception. However, some patients do not respond to conventional corticosteroid therapy. In this study, we investigated the efficacy of intravenous immunoglobulin (IVIG) for serious digestive manifestations not responding to steroid.
METHODS
From April 1999 to January 2005, 22 children diagnosed as HSP with severe GI symptoms were included. Initially, all patients were treated with intravenous methylprednisolone. IVIG 2 g/kg of body weight was infused in children refractory to steroid therapy. Clinical data were reviewed retrospectively.
RESULTS
Among 22 children, 12 children underwent IVIG therapy. The mean duration of corticosteroid therapy was 5.61+/-4.9 days before IVIG therapy, and 11 of 12 patients experienced disappearance of GI manifestations after the initiation of IVIG infusion. In one patient, IVIG was ineffective in relieving abdominal pain, but melena subsided. Comparison of the duration of hospitalization between IVIG group and corticosteroid group revealed no significant difference(12.8+/-7.6 days vs. 13.2+/-7.8 days, P=0.777). But, the total duration of abdominal pain decreased in IVIG group although the difference between two groups was not significant(8.8+/-8.1 days vs. 14.8+/-16.9 days, P=0.306). Among 10 children treated with steroid only, 2 children were operated for bowel perforation and intussusception. In contrast, there was no perforation in 12 children who underwent IVIG therapy.
CONCLUSION
IVIG could be the alternative therapy to corticosteroids in children with severe digestive manifestations of HSP.

Keyword

Henoch-Schonlein purpura; Gastrointestinal manifestation; Corticosteroid; Intravenous immunoglobulin; Children

MeSH Terms

Abdominal Pain
Adrenal Cortex Hormones
Body Weight
Child
Hemorrhage
Hospitalization
Humans
Immunoglobulins*
Immunoglobulins, Intravenous
Intussusception
Kidney
Melena
Methylprednisolone
Purpura, Schoenlein-Henoch*
Retrospective Studies
Skin
Systemic Vasculitis
Adrenal Cortex Hormones
Immunoglobulins
Immunoglobulins, Intravenous
Methylprednisolone