Razack Raidah Ayesha, Bajaber Abubakr O, Elsharkawy Ahmed, Alghitany Ahmad
College of Medicine, Alfaisal University, Riyadh, SAU.
Department of Medicine, Saudi German Hospital, Riyadh, SAU.
Cureus. 2023 Aug 6;15(8):e43054. doi: 10.7759/cureus.43054. eCollection 2023 Aug.
IgA nephropathy (IgAN), characterized as immune complex-mediated glomerulonephritis, can occasionally manifest alongside the pulmonary-renal syndrome. Henoch-Schönlein purpura (HSP), an inflammatory condition affecting small vessels through leukocytoclastic vasculitis, exhibits a close association with IgA nephropathy. Nonetheless, HSP's infrequent complications encompass pulmonary hemorrhage. Notably, the onset of pulmonary hemorrhage can rapidly precipitate a grave decline in the patient's health status, carrying a potentially fatal outcome for both disorders. Moreover, the existing literature regarding this specific complication and its management, particularly among adults, remains relatively limited. We report a rare case of a 43-year-old male with acute renal failure secondary to IgA nephropathy associated with HSP, whose condition was further complicated by pulmonary hemorrhage. He was treated with extensive plasmapheresis, pulse steroids, rituximab, and cyclophosphamide, which led to the successful recovery of his kidney function. Recognizing the potential of various presentations can significantly contribute to early diagnosis and prompt treatment, potentially leading to an improved prognosis for these patients.
IgA肾病（IgAN），其特征为免疫复合物介导的肾小球肾炎，偶尔可与肺肾综合征同时出现。过敏性紫癜（HSP）是一种通过白细胞破碎性血管炎影响小血管的炎症性疾病，与IgA肾病关系密切。然而，HSP罕见的并发症包括肺出血。值得注意的是，肺出血的发作可迅速导致患者健康状况严重恶化，对这两种疾病都可能带来致命后果。此外，关于这一特定并发症及其治疗，尤其是在成人中的现有文献仍然相对有限。我们报告了一例罕见病例，一名43岁男性因IgA肾病继发急性肾衰竭，同时伴有HSP，其病情因肺出血而进一步复杂化。他接受了广泛的血浆置换、脉冲式类固醇、利妥昔单抗和环磷酰胺治疗，最终肾功能成功恢复。认识到各种表现形式的可能性可显著有助于早期诊断和及时治疗，有可能改善这些患者的预后。
