A Case of Henoch-Sch nlein Purpura with Gastrointestinal Hemorrhage Diagnosed by Renal Biopsy / 대한소화기내시경학회지

ABSTRACT

Henoch-Sch nlein purpura is a systemic leukoclastic vasculitis with palpable purpura, gastrointestinal manifestations such as abdominal pain and gastrointestinal bleeding and renal problems. It is common in childhood, but can occur during adulthood. Adult have severer symptoms and worse prognosis than children. The pathogenesis of Henoch-Sch nlein purpura is autoimmune vasculitis mediated by immune complex such as IgA1. It is very helpful to find vasculitis and precipitation of immune complex (IgA1, C3) in the skin, gastrointestinal mucosal or renal biopsy for diagnosis. We report a case of Henoch-Sch nlein purpura with hematuria and proteinuria which could be diagnosed by renal needle biopsy due to absence of vasculitis findings in the skin and gastrointestinal mucosal biopsies. In summary, the pattern of evolution of this patient's dermatologic findings, gastrointestinal symptoms, bleeding, hematuria and proteinuria are typical of Henoch-Sch nlein purpura, but the definite diagnosis was very difficult due to absence of much related illness and no vasculitis in the skin and gastrointestinal mucosa. The meaning of renal biopsy in detection and management of Henoch-Sch nlein purpura with he maturia and proteinura was emphasized when vasculitis in the skin and gastrointestinal mucosa was not seen.