Rüdiger J J, Eriksson U, Schiller P, Leuppi J D
Medizin Klinik A und Dermatologie, Kantonsspital Universität Basel.
Dtsch Med Wochenschr. 2002 Jun 21;127(25-26):1382-4. doi: 10.1055/s-2002-32350.
An 80-year old female patient, hospitalised with pneumonia and myocardial infarction, suddenly developed fever, dyspnoea, malaise, arthralgia and crampy abdominal pain. On the following day, she developed a petechial rash and on the 6 (th) day, macroscopic haematuria. On physical examination, the patient presented with a temperature of 40 degrees C, tachypnoea, tachycardia, and on auscultation coarse crepitations at the left lower base. The abdomen was tender upon deep palpation but bowel sounds were normal. Initially the petechial rash was located at the trunk, later progressing towards the extremities.
Chest X-ray and laboratory tests were consistent with left lower lobe pneumonia. The clinical picture was not consistent with any haematological causes, coagulopathy or any medication the patient was taking. Rheumatological blood tests (involving ANA, ANCA, rheumatoid factors) were basically negative. A skin biopsy revealed microvessel necrosis and IgA deposits, verifying Henoch-Schoenlein Purpura. An immune electrophoresis revealed a selective IgG-deficiency, which may explain the cause for the patient's recurrent pneumonias.
The patient recovered well under antibiotic treatment and skin lesions healed without sequelae.
We present an unusual case of Henoch Schoenlein purpura associated with strictly petechial rash in an 80 year old female.
一名80岁女性患者因肺炎和心肌梗死住院，突然出现发热、呼吸困难、全身不适、关节痛和痉挛性腹痛。次日，她出现了瘀点疹，第6天出现肉眼血尿。体格检查时，患者体温40摄氏度，呼吸急促，心动过速，听诊左肺下叶基部有粗湿啰音。深触诊时腹部压痛，但肠鸣音正常。最初瘀点疹位于躯干，后来发展到四肢。
胸部X光和实验室检查结果与左肺下叶肺炎相符。临床表现与任何血液学病因、凝血病或患者正在服用的任何药物均不相符。风湿血液检查（包括抗核抗体、抗中性粒细胞胞浆抗体、类风湿因子）基本为阴性。皮肤活检显示微血管坏死和IgA沉积，确诊为过敏性紫癜。免疫电泳显示选择性IgG缺乏，这可能解释了患者反复发生肺炎的原因。
患者在抗生素治疗下恢复良好，皮肤病变愈合且无后遗症。
我们报告了一例80岁女性患有仅表现为瘀点疹的不寻常过敏性紫癜病例。
