title: Henoch-Schönlein pupura complicated by perforation of the gallbladder.
abstract: 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.
authors.affiliation: Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan. hashi@med.kitasato-u.ac.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hashimoto
authors.forename: Reiko
authors.initials: R
authors.lastname: Matsushita
authors.forename: Nobuko
authors.initials: N
authors.lastname: Iizuka
authors.forename: Miho
authors.initials: M
authors.lastname: Kimura
authors.forename: Toshimichi
authors.initials: T
authors.lastname: Matsui
authors.forename: Sumiaki
authors.initials: S
authors.lastname: Tanaka
authors.forename: Akira
authors.initials: A
authors.lastname: Ishikawa
authors.forename: Hirahito
authors.initials: H
authors.lastname: Endo
authors.forename: Shunsei
authors.initials: S
authors.lastname: Hirohata
mesh_terms: 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