A Case of Henoch-Schonlein Purpura Associated with Rotavirus Infection in an Elderly Asian Male and Review of the Literature.
BACKGROUND Henoch-Schönlein purpura (HSP), a small vessel vasculitis mediated by deposition of immune-complexes containing IgA in the skin, gut, and glomeruli, often presents with abdominal pain, purpuric rash in the lower extremities and buttocks, joint pain, and hematuria. The disease most commonly targets children but can affect adults who tend to have a worse prognosis. CASE REPORT We discuss a case of HSP in an elderly Chinese male who presented with severe proximal bowel inflammation, vasculitic rash, and proteinuria; he was found to have positive stool rotavirus and giardia. He improved significantly with high dose steroids. We believe rotavirus may have been a triggering event in this patient. A brief review of the literature is also presented. CONCLUSIONS This is the first case report describing a classic presentation of HSP in an adult following a rotavirus infection. HSP can cause significant morbidity and mortality in adult patients predominantly from progressive renal failure; therefore careful management and monitoring is important. GI infections seem to be a common trigger for HSP and this case report suggests that rotavirus may be part of the spectrum.
Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Chen
C
Tang
Department of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Daphne
D
Scaramangas-Plumley
Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Cynthia C
CC
Nast
Department of Nephrology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Zab
Z
Mosenifar
Department of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Marc A
MA
Edelstein
Department of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Michael
M
Weisman
D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D044466:Asian People; D005873:Giardiasis / Q000150:complications; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology; D007678:Kidney Glomerulus / Q000473:pathology; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D012400:Rotavirus Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D012867:Skin / Q000473:pathology; D016896:Treatment Outcome
D005938:Glucocorticoids