Naifa George, Totikidis George, Alexiadou Sonia, Kolona Christina, Mantadakis Elpis
Resident in Pediatrics, Department of Pediatrics, University General Hospital of Alexandroupolis, Alexandroupoli, Greece.
NHS Registra in Pediatrics, Department of Pediatrics, University General Hospital of Alexandroupolis, Alexandroupoli, Greece.
Case Rep Pediatr. 2020 Oct 17;2020:8867621. doi: 10.1155/2020/8867621. eCollection 2020.
IgA vasculitis (formerly known as Henoch-Schönlein purpura or anaphylactoid purpura) is a usually benign vasculitis that affects children of school age. The disease is characterized by the tetrad of palpable purpura, arthralgia/arthritis, abdominal pain, and hematuria. Treatment of IgA vasculitis is mainly supportive, with administration of simple analgesics. Corticosteroids have been shown to reduce and/or ameliorate the occurrence of abdominal pain which may be severe. We present two children with IgA vasculitis and severe abdominal pain despite corticosteroid administration, who responded promptly to intravenous globulin (IVIg) with complete resolution of their symptoms and review of the relevant medical literature. Given the toxicity and/or need for long-term administration of other second-line immunosuppressive therapies in corticosteroid-resistant IgA vasculitis, such as rituximab, cyclosporine, cyclophosphamide, azathioprine, or colchicine, we propose that IVIg may be a useful and safe treatment option, although randomized controlled clinical trials are needed in order to clarify its role in the treatment of abdominal pain in IgA vasculitis.
IgA血管炎（以前称为过敏性紫癜或类过敏性紫癜）是一种通常为良性的血管炎，影响学龄儿童。该疾病的特征为可触及的紫癜、关节痛/关节炎、腹痛和血尿四联征。IgA血管炎的治疗主要是支持性的，给予简单的镇痛药。已证明皮质类固醇可减少和/或改善可能严重的腹痛的发生。我们报告了两名患有IgA血管炎且尽管使用了皮质类固醇仍有严重腹痛的儿童，他们对静脉注射免疫球蛋白（IVIg）反应迅速，症状完全缓解，并对相关医学文献进行了综述。鉴于在皮质类固醇抵抗的IgA血管炎中使用其他二线免疫抑制疗法（如利妥昔单抗、环孢素、环磷酰胺、硫唑嘌呤或秋水仙碱）存在毒性和/或需要长期给药，我们建议IVIg可能是一种有用且安全的治疗选择，尽管需要进行随机对照临床试验以阐明其在IgA血管炎腹痛治疗中的作用。
