Different Clinical Courses of Henoch-Schonlein Purpura in Children, Adolescents and Adults

Hong, Joo Hee; Na, Hyung Joon; Namgoong, Mee Kyung; Choi, Seung Ok; Han, Byng Geun; Jung, Soon Hee; Kim, Hwang Min

Abstract

PURPOSE
Henoch-Schonlein purpura (HSP) is the most common and benign systemic vasculitis in children. Few reports have focused on worse outcomes of HSP in adults. The age of onset is suggested as a main risk factor. We assessed the characteristics of adolescent-onset HSP. METHODS: We retrospectively analyzed 205 cases presented from Aug. 1993 to Oct. 2003. Patients were classified as children (< 10 years of age), adolescents (10-20 years of age), and adults (> 20 years of age). RESULTS: The mean age was 5.7+/-1.8 years in 149 children, 13.5+/-2.4 years in 38 adolescents, and 44.9+/-14.5 years in 18 adults. The male to female ratio was 1.2: 1 in children and adolescents, and 2: 1 in adults. Previous upper respiratory infections were found in 53.4 percent of children, 32.4 percent of adolescents, and 33.3 percent of adults. Positivity of stool occult blood was more frequent in adults (50.5 percent) than in children (23.0 percent) (P< 0.05). Renal involvement was found in 46 cases (30.9 percent) of children, 23 cases (60.5 percent) of adolescents, and 15 cases (83.3 percent) of adults. Recurrences occurred in 23 cases (15.4 percent) of children, nine cases (23.7 percent) of adolescents, and three cases (16.7 percent) of adults. Among the cases with renal involvement, 97.8 percent of children and 87.0 percent of adolescents improved to normal or asymptomatic urinary abnormalities. 60.0 percent of adults persisted with severe nephropathy and 13.3 percent progressed to renal insufficiency. CONCLUSION: Although the outcome of adolescent HSP was as good as children, the clinical manifestations were similar to those of adults. Adolescents had the highest rate of recurrences. Thus long term observations may be needed in adolescent onset HSP.