Hemorrhagic Bullous Lesions in a 9-year-old Girl with Henoch-Scholein Purpura

Henoch-Schonlein purpura (HSP) is the most common vasculitis in children and is characterized by cutaneous purpura, arthritis, abdominal pain, and nephritis. Bullous skin lesions are rare in children. We report a case involving a 9-year-old female with HSP who displayed rapidly evolving hemorrhagic bullae from the primary purpuric lesions during systemic corticosteroid therapy. The bullae disappeared within 7 days of systemic corticosteroid therapy. Some scar lesions of the skin developed on acute phase recovered completely after 6 months. Bullae should not be considered as a poor prognostic factor of HSP and its renal outcome. Skin biopsy in HSP children with bullae is not necessary if clinical diagnostic criteria of HSP are met. However, further evaluation of more pediatric HSP with bullae is needed to get the clearer conclusions. We report a 9-year-old female with HSP who showed the rapidly evolving hemorrhagic bullae from primary purpuric lesions during systemic corticosteroid therapy.

A Case of Esophageal Involvement in Pemphigus Vulgaris / 대한소화기내시경학회지

Pemphigus vulgaris is a rare chronic disorder that is characterized by the development of bullae on the skin and mucous membrane due to an acantholysis mediated by circulating autoantibodies. It begins as painful, non- healing ulcerations in the mouth. After a period of weeks to months, the condition progresses to the skin. Occasionally, skin lesions may develop as the initial manifestation of this disease. However, esophageal involvement of pemphigus vulgaris is rare. An 84-year-old man was referred due to chest pain, dysphagia, oral ulcerations and facial bullae. The histopathological findings showed a suprabasal blister and acantholysis in the epithelium of the facial skin. An endoscopic examination revealed exfoliated erosions, ulcerations and hemorrhagic bullae on the oral and esophageal mucosa. The patient was started on high dose of corticosteroids and azathioprine, but there was no clinical improvement. The use of cyclophosphamide led to the remission of the lesions.

A Case of Henoch-Schonlein Purpura with Hemorrhagic Bullae in a Child

Henoch-Schonlein purpura(HSP) is a systemic small vessel vasculitis characterized by cutaneous purpura, arthritis, abdominal pain and nephritis. The characteristic rash of HSP consists of palpable purpura on the buttocks and lower extremities. Bullous lesions often appear in adults with HSP, whereas they are very rare in children with HSP. In this case report, the patient presented with arthralgia and abdominal pain and had hemorrhagic bullae as a prominent manifestation of the disease. The skin biopsy of the patient revealed typical leukocytoclastic vasculitis of dermal vessels and prominent IgA and fibrinogen deposits on capillary walls by direct immunofluorescence. We confirmed the diagnosis of HSP and observed improvement of clinical symptoms and signs within a few days after corticosteroid treatment. We therefore report a case with a review of the literature.

A Case of Churg-Strauss Syndrome Showing Hemorragic Bullae / 대한피부과학회지

A 61-year old woman was presented with various sized, tense and hemorrhagic bullae on the extremities with edema for 10 days. She had a history of bronchial asthma and had a tingling sensation on both legs. Laboratory findings showed leukocytosis, hypereosinopilia and p-ANCA(+). Chest radiograph showed patchy infiltrations in the left upper lobe. Water's view showed bilateral maxillary antral mucosal thickening. Electromyography showed polyneuropathy on both lower legs. Histopathologically, there were conspicuous infiltration of eosinophils within bulla and around vessels in the dermis and radially distributed histiocytes in the degenerated collagen. Treatment with prednisolone 30 mg per day showed a dramatic improvement in symptoms.