Pulmonary hemorrhage associated with Henoch-Schönlein purpura in a child.
Swelling of the right ankle and purpura on the bilateral lower extremities of a 6-year-old boy indicated a diagnosis of Henoch-Schönlein purpura (HSP). The patient was referred to our hospital because of severe abdominal pain that was unresponsive to prednisolone. Respiratory symptoms and pulmonary infiltrates on chest X-ray were absent upon admission. Methylprednisolone pulse therapy gradually improved the abdominal symptoms, but tachypnea developed, and insufficient aeration of the right lung was accompanied by a decline in percutaneous oxygen saturation from 99% to 90% and a rapid decrease in hemoglobin levels from 11.7 to 7.6 g/dL. Chest X-rays and high-resolution computed tomography scans showed widespread consolidation and patchy opacities predominantly in the right lung fields, suggesting acute pulmonary hemorrhage. Intravenous cyclosporin A (CyA) gradually resolved the pulmonary hemorrhage and respiratory insufficiency. Pulmonary hemorrhage, as a complication of HSP, is extremely rare and sometimes fatal. Aggressive steroid and immunosuppressive treatment is required to address severe complications of HSP.
Matsubayashi
Rie
R
Department of Pediatrics, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka 430-8558, Japan.
Matsubayashi
Tadashi
T
Fujita
Naoya
N
Yokota
Takuya
T
Ohro
Yoichiro
Y
Enoki
Hideo
H
D000208:Acute Disease; D002648:Child; D005938:Glucocorticoids / Q000008:administration & dosage; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D011652:Pulmonary Circulation; D020551:Pulse Therapy, Drug; D014057:Tomography, X-Ray Computed
D005938:Glucocorticoids; D008775:Methylprednisolone