Henoch-Schönlein pupura complicated by perforation of the gallbladder.
Henoch-Schönlein purpura is a systemic vasculitis of small vessels characterized by purpura, arthralgias, glomerulonephritis and gastrointestinal involvements which can cause intestinal perforation. A 75-year-old man with renal dysfunction and palpable purpura (petechiae) of which dermal specimen showed leukocytoclastic vasculitis was diagnosed as Henoch-Schönlein purpura. Corticosteroid and cyclosporine were effective, but subsequently he developed pneumocystis pneumonia. After he improved by treatment with trimethoprim-sulfamethoxazole, he presented sudden abdominal pain, caused by perforation of the gallbladder. Histological analysis revealed infiltration of inflammatory cells with bleeding in the gallbladder wall at the site of perforation. It is suggested that inflammatory disruption of capillary walls might lead to the perforation of the gallbladder.
Hashimoto
Atsushi
A
Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan. hashi@med.kitasato-u.ac.jp
Matsushita
Reiko
R
Iizuka
Nobuko
N
Kimura
Miho
M
Matsui
Toshimichi
T
Tanaka
Sumiaki
S
Ishikawa
Akira
A
Endo
Hirahito
H
Hirohata
Shunsei
S
D000005:Abdomen / Q000000981:diagnostic imaging; D015746:Abdominal Pain / Q000150:complications / Q000209:etiology; D000368:Aged; D002763:Cholecystectomy; D005704:Gallbladder / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D007416:Intestinal Perforation / Q000150:complications* / Q000209:etiology; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge; D010533:Peritoneal Lavage; D016896:Treatment Outcome; D014463:Ultrasonography