Cerebral vasculitis and intracerebral hemorrhage in Henoch-Schönlein purpura treated with plasmapheresis.
Severe neurological complications in Henoch-Schonlein purpura (HSP) are rare. We report a 13-year-old girl with HSP receiving oral steroid therapy for HSP nephritis who presented with acute onset of headache, confusion, and loss of bilateral vision. However, immediate cranial computed tomography showed merely a small intracranial hematoma in the left occipital area, which was not consistent with her clinical manifestations. The subsequent magnetic resonance imaging of the brain demonstrated bilateral, multifocal abnormalities with features consistent with cerebral vasculitis. Therapeutic plasmapheresis was performed immediately and there was rapid clinical improvement. In conclusion, we propose that plasmapheresis is a reliable and effective therapy and may be considered as the first-line treatment in this critical condition to prevent massive intracerebral hemorrhagic complication of this immune complex-mediated cerebral vasculitis leading to irreversible neurological sequelae or mortality.
Wen
Yao-Ko
YK
Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, 135 Nansiao Street, 500 Changhua, Taiwan, Republic of China. 9965@cch.org.tw
Yang
Yu
Y
Chang
Chia-Chu
CC
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications*; D008279:Magnetic Resonance Imaging; D009393:Nephritis / Q000188:drug therapy / Q000209:etiology; D010956:Plasmapheresis; D020293:Vasculitis, Central Nervous System / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*
D000305:Adrenal Cortex Hormones