DOI: http://dx.doi.org/10.18203/issn.2455-4529.IntJResDermatol20211718

The enigma of adult onset Henoch Schoenlein purpura and leucocytoclastic Vasculits: a case report

Vasudha A. Belgaumkar, Ravindranath B. Chavan, Nitika S. Deshmukh, Ranjitha K. Gowda

Abstract


Leukocytoclastic vasculitis (LCV), also known as hypersensitivity vasculitis is a small vessel inflammatory disease which mainly involves the postcapillary venules. It can be idiopathic or secondary to connective tissue diseases, infection, malignancy. A 39 year old male presented with a recurrent episode of multiple palpable purpurae over the legs, trunk, back and upper limbs with diffuse abdominal pain, bloody diarrhoea and arthralgia. Anti-nuclear antibodies (ANA) were positive, but ANA profile was equivocal. Histopathological examination confirmed leukocytoclastic vasculitis. A final diagnosis of Henoch Schoenlein purpura (HSP) was reached based on EULAR Criteria. He was treated with tapering doses of prednisolone, hydroxychloroquine and bed rest with limb elevation. All symptoms and lesions gradually resolved. Various sub-types of cutaneous small vessel vasculitis may mimic each other, warranting a meticulous evaluation. Adult onset HSP though rare must be considered in the differential diagnosis of LCV, which might be the presenting manifestation of an underlying connective tissue disease. Hence long-term follow-up with stringent clinical and laboratory monitoring is recommended.


Keywords


Leukocytoclastic vasculitis, Henoch Schoenlein purpura, Hypersensitivity vasculitis

Full Text:

PDF

References


Leukocytoclastic Vasculitis. Available at: https://www.ncbi.nlm.nih.gov/books/NBK482159/. Accessed on 2 March 2021.

Abdgawad M. History, classification and pathophysiology of small vessel vasculitis. Updates in the diagnosis and treatment of vasculitis. Intech Open. 2013:1-30.

Piubelli MLM, Felipe-Silva A, Kanegae MY, Ferraz CFP. Fatal necrotizing Candida esophagitis in a patient with leukocytoclastic cutaneous vasculitis and ankylosing spondylitis. Autops Case Rep. 2019;9(2):e2018070.

Younger DS, Carlson A. Dermatologic aspects of systemic vasculitis. Neurol Clin. 2019;37(2):465-73.

Alquorain NAA, Aljabr ASH, Alghamdi NJ. Cutaneous polyarteritis nodosa treated with pentoxifylline and clobetasol propionate: a case report. Saudi J Med Med Sci. 2018;6(2):104-7.

Einhorn J, Levis JT. Dermatologic diagnosis: leukocytoclastic vasculitis. Perm J. 2015;19(3):77-8.

Rheumatology advisor. Leukocytoclastic vasculitis. Available at: https://www.rheumatologyadvisor.com/home/decision-support-in-medicine/rheumatology/leukocytoclastic-vasculitis/. Accessed on 2 March 2021.

Fekete GL, Fekete L. Cutaneous leukocytoclastic vasculitis associated with erlotinib treatment: A case report and review of the literature. Exp Ther Med. 2019;17(2):1128-31.

Li X, Xia J, Padma M, Ma Z, Tian Y. Cutaneous leukocytoclastic vasculitis as the first manifestation of malignant syphilis coinfected with human immunodeficiency virus. J Cutan Pathol. 2019;46(5):393-5.

Borahay MA, Kelly BC, Harirah HM. Systemic lupus erythematosus presenting with leukocytoclastic vasculitis and seizure during pregnancy. Am J Perinatol. 2009;26(6):431-5.

Yang YH, Yu HH, Chiang BL. The diagnosis and classification of Henoch-Schönlein purpura: an updated review. Autoimmun Rev. 2014;13(4-5):355-8.

Jithpratuck W, Elshenawy Y, Saleh H, Youngberg G, Chi DS, Krishnaswamy G. The clinical implications of adult-onset henoch-schonelin purpura. Clin Mol Allergy. 2011;9(1):9.

Pillebout E, Thervet E, Hill G, Alberti C, Vanhille P, Nochy D. Henoch-Schönlein Purpura in adults: outcome and prognostic factors.J Am Soc Nephrol. 2002;13(5):1271-8.

Russell JP, Gibson LE. Primary cutaneous small vessel vasculitis: approach to diagnosis and treatment. Int J Dermatol. 2006;45(1):3-13.

Pillebout E, Thervet E, Hill G, Alberti C, Vanhille P, Nochy D. Henoch-Schönlein Purpura in adults: outcome and prognostic factors. J Am Soc Nephrol. 2002;13(5):1271-8.