Pulmonary tuberculosis presenting as henoch-schönlein purpura: Case report and literature review

• Published in: Medicine (Baltimore) Vol. 99; no. 40; p. e22583
• Main Authors: Li, Jie, Wang, Xiao-Zi, Wang, Rui-Cang, Yang, Jie, Hao, Hong-Ling, Xue, Li-Ying
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 02.10.2020
• Subjects: Abdominal Pain - diagnosis; Abdominal Pain - etiology; Aftercare; Antitubercular Agents - therapeutic use; Ascorbic Acid - therapeutic use; Chlorpheniramine - therapeutic use; Clinical Case Report; Diagnosis, Differential; Fever - diagnosis; Fever - etiology; Gastrointestinal Hemorrhage - diagnosis; Gastrointestinal Hemorrhage - etiology; Histamine H1 Antagonists - therapeutic use; Humans; IgA Vasculitis - drug therapy; IgA Vasculitis - etiology; Interferon-gamma Release Tests - methods; Male; Treatment Outcome; Tuberculin; Tuberculosis, Pulmonary - blood; Tuberculosis, Pulmonary - complications; Tuberculosis, Pulmonary - diagnostic imaging; Tuberculosis, Pulmonary - drug therapy; Vitamins - therapeutic use; Young Adult
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000022583

Henoch-Schönlein purpura (HSP) is an extremely rare condition in patients with pulmonary tuberculosis, with only a few reported cases. Compared to patients with typical clinical symptoms, it is difficult to make a definitive diagnosis when HSP presents as an initial manifestation in pulmonary tuberculosis patients. Herein, a case of pulmonary tuberculosis that showed HSP at first was reported, and the related literatures were reviewed. A 24-year-old man presented with palpable purpura on the extremities, accompanied by abdominal pain, bloody stools, and knee pain. The patient was diagnosed with pulmonary tuberculosis based on the results of interferon gamma release assays, purified protein derivative test, and computed tomography. The patient was treated with vitamin C and chlorpheniramine for 2 weeks, and the above-mentioned symptoms were relieved. However, 3 weeks later, the purpura recurred with high-grade fever and chest pain during the inspiratory phase. The patient was then treated with anti-tuberculosis drugs, and the purpura as well as the high fever disappeared. The patient recovered well and remained free of symptoms during the follow-up examination. Pulmonary tuberculosis presenting with HSP as an initial manifestation is not common. Therefore, it is difficult to clinically diagnose and treat this disease. When an adult patient shows HSP, it is important to consider the possibility of tuberculosis to avoid misdiagnosis and delayed treatment.