Bose Subhasish, Pathireddy Samata, Baradhi Krishna M, Aeddula Narothama Reddy
Department of Nephrology, Lynchburg Nephrology, Lynchburg, Virginia, USA.
Department of Internal Medicine, Deaconess Health System, Evansville, Indiana, USA.
BMJ Case Rep. 2019 Jul 17;12(7):e229939. doi: 10.1136/bcr-2019-229939.
A 30-year-old Caucasian woman with no prior medical history presented with pedal oedema, arthralgias and abdominal pain with diarrhoea, following a respiratory infection. She had mild abdominal tenderness along with a purpuric rash on the extremities and was anaemic. Following initial workup for anaemia and rash, her condition deteriorated with renal impairment, respiratory failure and seizures necessitating ventilatory support, dialysis and steroids. Serologies were negative, and skin biopsy showed leucocytoclastic vasculitis without vascular IgA deposition, and renal biopsy showed subendothelial, mesangial deposits of IgA with C3 indicative of Henoch-Schonlein purpura (HSP). She was treated with steroids, haemodialysis and on 6-month follow-up recovered renal function. We present the case to illustrate that HSP, though rare in adults, can present with multiorgan failure, with renal, pulmonary and central nervous system involvement, and the need for early diagnosis and prompt treatment for rapid clinical recovery.
一名30岁无既往病史的白种女性，在呼吸道感染后出现足部水肿、关节痛、腹痛伴腹泻。她有轻度腹部压痛，四肢有紫癜样皮疹，且有贫血。在对贫血和皮疹进行初步检查后，她的病情恶化，出现肾功能损害、呼吸衰竭和癫痫发作，需要通气支持、透析和使用类固醇。血清学检查为阴性，皮肤活检显示白细胞破碎性血管炎，无血管IgA沉积，肾活检显示IgA在肾小球内皮细胞下、系膜沉积，伴有C3，提示为过敏性紫癜（HSP）。她接受了类固醇和血液透析治疗，6个月随访时肾功能恢复。我们报告该病例以说明，HSP虽然在成人中罕见，但可表现为多器官功能衰竭，累及肾脏、肺和中枢神经系统，且需要早期诊断和及时治疗以实现快速临床康复。
