[The first manifestations of Schönlein-Henoch purpura in a 74-year-old female patient with hyperthyroidism].
METHODS
A 74-year-old woman had for 3 weeks suffered from watery diarrhoea and diffuse abdominal pain. She felt restless, had a subfebrile temperature (37.8 degrees C), tachycardia and a blood pressure of 190/90 mmHg. Shortly after admission petechiae were found over the lower legs and she complained of joint pains.


METHODS
Laboratory tests established hyperthyroidism. Skin biopsy showed leukocytoclastic vasculitis. Tests for antinuclear antibodies, antistreptolysin titre, rheumatoid factors, cryoglobulins and TSH-receptor antibodies were negative, immunoglobulin A (IgA) was raised.


METHODS
As a drug-induced vasculitis was suspected treatment was started with methylprednisolone, 100 mg daily. Proteinuria (5.6 g daily) indicated renal biopsy, which revealed focal glomerulonephritis with deposits of IgA, fibrin/fibrinogen and complement factor 3. Gastroscopic biopsy, performed after an episode of gastrointestinal bleeding, demonstrated necrotizing vasculitis, confirming the diagnosis of Schönlein-Henoch-purpura (SHP). As the patient's condition rapidly worsened, cyclophosphamide was started additionally (2 mg/kg). She died on the 17th hospital day from acute cardiac failure.


CONCLUSIONS
The lethal course of the disease in this elderly patient illustrates a previously not reported close temporal and clinical relationship between SHP and hyperthyroidism.
Kamm
M
M
Medizinische Klinik IV, Universität Erlangen-Nürnberg.
John
S
S
Riess
R
R
Geiger
H
H
D015746:Abdominal Pain / Q000175:diagnosis / Q000473:pathology; D000368:Aged; D001706:Biopsy; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000175:diagnosis / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D005922:Glomerulonephritis, IGA / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D006980:Hyperthyroidism / Q000175:diagnosis* / Q000473:pathology; D011695:IgA Vasculitis / Q000175:diagnosis* / Q000473:pathology; D007668:Kidney / Q000473:pathology
Erstmanifestation einer Schönlein-Henoch-Purpura bei einer 74jährigen Patientin mit Hyperthyreose.