title: [Henoch-Schönlein purpura associated with pulmonary tuberculosis].
abstract: A 34-year-old man was admitted to our hospital because of cough and fever. Chest radiograph showed multiple cavities mainly on the right lung. His sputum was positive for acid-fast bacilli on smear, and he was treated with daily isoniazide, rifampicin and streptomycin. Antituberculous treatment was successfully performed, so acid-fast bacilli of his sputa disappeared on smear and culture. Five months later, he developed a purpuric lesions over both legs accompanied by low grade fever and arthralgia, but proteinuria and abdominal pain could not be observed. Laboratory findings showed a normal platelet count and a normal bleeding time. High levels of serum IgG, IgA, C3 and C4 were evident. ASLO and ASK titer were elevated and they markedly increased within two weeks. A direct invasion of the vessel wall by tubercle bacilli is deniable because antituberculous treatment was successfully continued. Henoch-Schönlein purpura was diagnosed judging from these findings. High levels of ASLO and ASK suggest a preceding streptococcal infection for developing purpura but a possible infectious focus could not be identified. He was treated with 15 mg of prednisolone daily for two weeks and the lesion was subsided. The effect of prednisolone suggests that a subsequent antigen-antibody interaction caused by a streptococcal infection may participate in the formation of the purpura.
authors.affiliation: Division of Internal Medicine, National Sanatorium Minami-Okayama Hospital, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Mishima
authors.forename: M
authors.initials: M
authors.lastname: Takeuchi
authors.forename: K
authors.initials: K
authors.lastname: Kamisaka
authors.forename: C
authors.initials: C
authors.lastname: Okada
authors.forename: A
authors.initials: A
authors.lastname: Tada
authors.forename: S
authors.initials: S
authors.lastname: Kawahara
authors.forename: R
authors.initials: R
authors.lastname: Soda
authors.forename: K
authors.initials: K
authors.lastname: Takahashi
authors.forename: M
authors.initials: M
authors.lastname: Kibata
mesh_terms: D000328:Adult; D006801:Humans; D011695:IgA Vasculitis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D013290:Streptococcal Infections / Q000150:complications*; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000188:drug therapy