Torosoff Mikhail, Breen Thomas, Balulad Sujata, Padala Santosh, Lyubarova Radmila, Tan Henry, Sidhu Mandeep
Albany Medical Center, Albany, New York, USA.
Mount Sinai Hospital, New York, New York, USA.
Intern Med J. 2018 Jul;48(7):868-871. doi: 10.1111/imj.13948.
Henoch-Schonlein purpura (HSP) is a rare, typically self-limited, multi-organ vasculitis. Cardiac involvement with HSP carries high morbidity and mortality, thus requiring early aggressive immunosuppressive therapy. We report a case of HSP complicated with acute systolic left ventricular (LV) dysfunction, symptomatic sinus bradycardia and high-grade atrio-ventricular (AV) heart block. Cyclophosphamide, a commonly used agent in HSP, was contraindicated due to the patient's presentation with acute renal failure. Treatment with monoclonal antibody rituximab and corticosteroids was initiated with an improvement in and resolution of LV systolic dysfunction, sinus bradycardia and AV block. We believe this is the first published report on rituximab treatment in HSP with cardiac involvement manifesting with severe LV systolic dysfunction, sinus bradycardia and high-grade AV block.
过敏性紫癜（HSP）是一种罕见的、通常为自限性的多器官血管炎。HSP累及心脏时具有较高的发病率和死亡率，因此需要早期积极的免疫抑制治疗。我们报告一例HSP并发急性收缩期左心室（LV）功能障碍、症状性窦性心动过缓和高度房室（AV）传导阻滞的病例。由于患者出现急性肾衰竭，常用的HSP治疗药物环磷酰胺被列为禁忌。开始使用单克隆抗体利妥昔单抗和皮质类固醇进行治疗后，LV收缩功能障碍、窦性心动过缓和AV传导阻滞得到改善并消失。我们认为这是关于利妥昔单抗治疗累及心脏、表现为严重LV收缩功能障碍、窦性心动过缓和高度AV传导阻滞的HSP的首篇发表报告。
