[Henoch-Schönlein purpura associated with pulmonary tuberculosis].
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.
Mishima
Y
Y
Division of Internal Medicine, National Sanatorium Minami-Okayama Hospital, Japan.
Takeuchi
M
M
Kamisaka
K
K
Okada
C
C
Tada
A
A
Kawahara
S
S
Soda
R
R
Takahashi
K
K
Kibata
M
M
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