title: High-dose methylprednisolone pulse therapy for treatment of refractory intestinal involvement caused by Henoch-Schönlein purpura: a case report.
abstract: BACKGROUND
  Henoch-Schönlein purpura is an immunoglobulin A-mediated, small vascular inflammatory disease that can be associated with palpable purpura, arthralgia, abdominal pain, or nephritis. The presence of purpura facilitates the diagnosis of Henoch-Schönlein purpura at the onset of associated symptoms, whereas the absence of purpura makes the diagnosis challenging. It is important to diagnose Henoch-Schönlein purpura with delayed-onset skin purpura to avoid unnecessary surgery for acute abdomen. Most cases of Henoch-Schönlein purpura with severe abdominal pain are treated with low-dose steroids and intravenous immunoglobulin.
  
  
  METHODS
  A 15-year-old Korean girl complained of severe abdominal pain and delayed-onset purpura on admission. Henoch-Schönlein purpura was diagnosed based on endoscopic findings of hemorrhagic duodenitis and duodenal vasculitis and abdominal computed tomography findings of edematous bowels. Two common initial treatments, a low-dose steroid and intravenous immunoglobulin, were administered, but there was no improvement for 1 month. Subsequently, we used high-dose intravenous methylprednisolone pulse therapy (30 mg/kg/day, with a maximum of 1g/day), which dramatically alleviated her abdominal symptoms.
  
  
  CONCLUSIONS
  High-dose intravenous methylprednisolone pulse therapy can be used as the ultimate treatment for delayed-onset Henoch-Schönlein purpura with severe abdominal pain when symptoms do not improve after low-dose steroid and intravenous immunoglobulin treatments.
authors.affiliation: Department of Pediatrics, Jeju National University Hospital, Aran 13gil 15, Jeju-si, Jeju Special Self-Governing Province, 690-767, Korea. medyapsb@naver.com.
authors.forename: Hyun Sik
authors.initials: HS
authors.lastname: Kang
authors.affiliation: Jeju National University School of Medicine, Aran 13gil 15, Jeju-si, Jeju Special Self-Governing Province, 690-767, Korea. heesup1982@naver.com.
authors.forename: Hee Sup
authors.initials: HS
authors.lastname: Chung
authors.affiliation: Department of Pediatrics, Jeju National University Hospital, Aran 13gil 15, Jeju-si, Jeju Special Self-Governing Province, 690-767, Korea. kskang@jejunu.ac.kr.|Department of Pediatrics, Jeju National University School of Medicine, Aran 13gil 15, Jeju-si, Jeju Special Self-Governing Province, 690-767, Korea. kskang@jejunu.ac.kr.
authors.forename: Ki-Soo
authors.initials: KS
authors.lastname: Kang
authors.affiliation: Department of Pediatrics, Jeju National University Hospital, Aran 13gil 15, Jeju-si, Jeju Special Self-Governing Province, 690-767, Korea. hansyang78@gmail.com.|Department of Pediatrics, Jeju National University School of Medicine, Aran 13gil 15, Jeju-si, Jeju Special Self-Governing Province, 690-767, Korea. hansyang78@gmail.com.
authors.forename: Kyoung Hee
authors.initials: KH
authors.lastname: Han
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D004382:Duodenitis / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications*; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007155:Immunologic Factors / Q000627:therapeutic use; D008775:Methylprednisolone / Q000008:administration & dosage*; D014657:Vasculitis / Q000188:drug therapy
chemical_list: D000893:Anti-Inflammatory Agents; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D008775:Methylprednisolone