Massive gastrointestinal hemorrhage caused by Henoch-Schoenlein purpura: A case report

• Published in: Medicine (Baltimore) Vol. 100; no. 50; p. e28240
• Main Authors: Wang, Shuo, Tang, Hongyan, Du, Wei, Ding, Yiyi
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 17.12.2021
• Subjects: Abdominal Pain - etiology; Child; Clinical Case Report; Gastrointestinal Hemorrhage - etiology; Hematemesis - etiology; Humans; IgA Vasculitis - complications; IgA Vasculitis - drug therapy; Male; Methylprednisolone - adverse effects; Methylprednisolone - therapeutic use
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000028240

Henoch-Schoenlein purpura (HSP) is a systemic small-vessel vasculitis that commonly occurs in children. Gastrointestinal HSP can rarely progress to gastrointestinal perforation, followed by massive gastrointestinal bleeding. An 8-year-old Chinese boy was transferred to the pediatric intensive care unit of our hospital with an emergency occurrence of purpura, severe hematemesis, large bloody stools, and sharp abdominal pain, and complained of abdominal pain and rash 2 weeks prior. The patient had purpura with lower limb predominance, abdominal pain, and gastrointestinal bleeding. Immunofluorescence microscopy of histological sections showed granular and lumpy IgA focal deposition in the blood vessel walls. He was diagnosed with HSP. Initially, he was treated with methylprednisolone, posterior pituitary injection, somatostatin, and hemocoagulase, together with the infusion of large blood products. Postoperatively, he was administered nasal continuous positive airway pressure -assisted ventilation, anti-infection treatment, albumin transfusion, platelet transfusion, abdominal drainage, methylprednisolone, fluconazole anti-fungal treatment, and wound dressing. There was no evidence of rebleeding, abdominal pain, or purpura at the 2-month follow-up assessment. Abdominal HSP should be alert to gastrointestinal perforation when using hormone therapy.