Thongprayoon Charat, Cheungpasitporn Wisit, Thamcharoen Natanong, Bruminhent Jackrapong
Mayo Clinic, Rochester, Minnesota, USA.
Mayo Clinic, Rochester, Minnesota, USA ; Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
N Am J Med Sci. 2014 Oct;6(10):543-4. doi: 10.4103/1947-2714.143289.
Henoch-Schönlein purpura (HSP), a systemic IgA vascultitis, is uncommon in adults, with an incidence rate of 0.1 to 1.2 per million in adults over 20 years old. This vasculitic syndrome can present as an uncommon cause of intestinal obstruction in older patients. We report a case of an older woman with HSP presenting with small bowel obstruction and vasculitic rash.
We report a 67-year-old woman who presented with small bowel obstruction and skin rash. Skin biopsy revealed leukocytoclastic vasculitis with +IgA granular deposition within the walls of superficial dermal vessels. Kidney biopsy confirmed the diagnosis of HSP with mild mesangial proliferative IgA nephropathy. Her abdominal pain and small bowel obstruction were improved with conservative treatment. She continued to do well with normal kidney function at a 3-month follow-up visit.
HSP, a systemic IgA vasculitis, is a predominantly pediatric vasculitis and is uncommon in adults. In adults, the disease process is identical to that in children. However, gastrointestinal manifestation is less common in older patients, and bowel perforation and obstruction are rare. Intestinal obstruction with skin rash and renal involvement should raise suspicions of HSP.
过敏性紫癜（HSP）是一种全身性IgA血管炎，在成年人中并不常见，20岁以上成年人的发病率为百万分之0.1至1.2。这种血管炎综合征在老年患者中可能是肠梗阻的罕见病因。我们报告一例老年女性过敏性紫癜患者，表现为小肠梗阻和血管炎性皮疹。
我们报告一名67岁女性，表现为小肠梗阻和皮疹。皮肤活检显示白细胞破碎性血管炎，真皮浅层血管壁内有IgA颗粒沉积（+）。肾脏活检确诊为过敏性紫癜伴轻度系膜增生性IgA肾病。经保守治疗，她的腹痛和小肠梗阻得到改善。在3个月的随访中，她肾功能正常，情况良好。
过敏性紫癜是一种全身性IgA血管炎，主要是儿童期血管炎，在成年人中并不常见。在成年人中，疾病过程与儿童相同。然而，老年患者的胃肠道表现较少见，肠穿孔和肠梗阻罕见。伴有皮疹和肾脏受累的肠梗阻应怀疑为过敏性紫癜。
