Tuberc Respir Dis.  2009 Sep;67(3):226-228.

A Case of Pulmonary Hemorrhage Associated with Henoch-Schonlein Purpura

• Sim YS
• Choi MY
• Oh JY
• Lee JH
• Moon JW
• Choi KB
• Ahn JH
• Kim YK
• Sung SH
• Chang JH

Abstract

Henoch-Schonlein purpura (HSP) is an immunologically mediated systemic vasculitis of small blood vessels that primarily involves the skin, gastrointestinal tract, joints and kidneys. HSP is a common vasculitic syndrome in children who, in most cases, achieve complete recovery. Pulmonary hemorrhage is a very rare manifestation of HSP. The authors present a case of a 46-year-old male presenting with pulmonary hemorrhage and renal involvement and the diagnosis of HSP. The patient responded to prednisolone therapy.

Keyword

Henoch-Schonlein purpura; Pulmonary hemorrhage; Ig A

MeSH Terms

Blood Vessels
Child
Gastrointestinal Tract
Hemorrhage
Humans
Joints
Kidney
Male
Middle Aged
Prednisolone
Purpura, Schoenlein-Henoch
Skin
Systemic Vasculitis
Prednisolone

Figure

• 

  Figure 1 Ill-defined nodular opacity at the right middle lung zone and minimal reticulonodular infiltration at the right upper lobe apex.

• 

  Figure 2 A partially calcified nodule with a fibrotic linear opacity at the right upper lobe apex and an enhanced wedge-shaped lobulated mass at the superior segment of the right lower lobe.

• 

  Figure 3 Overall architecture of the glomeruli was well preserved and capillary loops were intact and patent (H&E stain, ×400).

• 

  Figure 4 Mild mesangial Ig A deposits in the mesangium of glomeruli. (IF ×400).

Reference

1. Levy M, Broyer M, Arsan A, Levy-Bentolila D, Habib R. Anaphylactoid purpura nephritis in childhood. Adv Nephrol Necker Hosp. 1976. 6:183–228.

2. Jacome AF. Pulmonary haemorrhage and death complicating anaphylactoid purpura. South Med J. 1967. 60:1003–1004.

3. Roth DA, Wilz DR, Theil GB. Schönlein-Henoch syndrome in adults. Q J Med. 1985. 55:145–152.

4. Hoffman GS, Kerr GS, Leavitt RY, Hallahan CW, Lebovics RS, Travis WD, et al. Wegener granulomatosis: an analysis of 158 patients. Ann Intern Med. 1992. 116:488–498.

5. Sullivan EJ, Hoffman GS. Pulmonary vasculitis. Clin Chest Med. 1998. 19:759–776.

6. Kelly WN, Harris ED Jr, Ruddy S, Sledge C. Textbook of rheumatology. 1993. 4th ed. Philadelphia: WB Saunders.

7. Hall SL, Miller LC, Duggan E, Mauer SM, Beatty EC, Hellerstein S. Wegener granulomatosis in pediatric patients. J Pediatr. 1985. 106:739–744.

8. Paller AS, Kelly K, Sethi R. Pulmonary hemorrhage: an often fatal complication of Henoch-Schönlein purpura. Pediatr Dermatol. 1997. 14:299–302.

9. Kathuria S, Cheifec G. Fatal pulmonary Henoch-Schönlein syndrome. Chest. 1982. 82:654–656.

10. Weiss VF, Naidu S. Fatal pulmonary hemorrhage in Henoch-Schönlein purpura. Cutis. 1979. 23:687–688.

11. Markus HS, Clark JV. Pulmonary haemorrhage in Henoch-Schönlein purpura. Thorax. 1989. 44:525–526.

12. Saulsbury FT. Henoch - Schönlein purpura in children: report of 100 patients and review of the literature. Medicine (Baltimore). 1999. 78:395–409.