title: Polyangitis overlap syndrome: a fatal case combined with adult Henoch-Schönlein purpura and polyarteritis nodosa.
abstract: Henoch-Schönlein purpura (HSP) is a rather common disease characterized by systemic hypersensitivity vasculitis in the skin and other visceral organs. It has a favorable prognosis unless it is complicated by severe glomerular disease. We report a distinctive fatal case of systemic vasculitis combined with HSP and polyarteritis nodosa (PN) in a 56-year-old man who died of progressive renal failure one month after the onset of the disease. He complained of arthralgia, purpura of both lower extremities, nasal bleeding and tarry stool, and acute renal failure was noted at the time of admission to hospital. A skin biopsy from the purpura lesion exhibited leucocytoclastic vasculitis with IgA deposition, and HSP was considered. However, renal failure progressed rapidly and subsequently was complicated by acute myocardial infarction. Postmortem examination revealed PN type necrotizing vasculitis in the kidneys, heart and mesentery resulting in acute multiple infarctions of these organs. We think the current case was a polyangitis overlap syndrome. It is important to suspect the polyangitis overlap syndrome positively when progressive acute renal failure is seen in a patient with HSP and to begin appropriate therapy immediately.
authors.affiliation: Pathology Division, Fukushima Medical University School of Medicine Hospital, Fukushima, Japan. w-kazuo@fmu.ac.jp
authors.forename: Kazuo
authors.initials: K
authors.lastname: Watanabe
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Abe
authors.forename: Tomoko
authors.initials: T
authors.lastname: Mishima
authors.forename: Go
authors.initials: G
authors.lastname: Ogura
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Suzuki
mesh_terms: D017809:Fatal Outcome; D006499:Hepatic Artery / Q000473:pathology; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications* / Q000473:pathology*; D007238:Infarction / Q000150:complications / Q000473:pathology; D007668:Kidney / Q000098:blood supply / Q000473:pathology; D008297:Male; D008638:Mesenteric Arteries / Q000473:pathology; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D010488:Polyarteritis Nodosa / Q000150:complications* / Q000473:pathology*; D051437:Renal Insufficiency / Q000209:etiology; D012867:Skin / Q000473:pathology; D014657:Vasculitis / Q000150:complications* / Q000473:pathology*