High-dose methylprednisolone pulse therapy for treatment of refractory intestinal involvement caused by Henoch-Schönlein purpura: a case report

• Published in: Journal of medical case reports Vol. 9; no. 1; p. 65
• Main Authors: Kang, Hyun Sik, Chung, Hee Sup, Kang, Ki-Soo, Han, Kyoung Hee
• Format: Journal Article
• Language: English
• Published: England BioMed Central 24.03.2015
• Subjects: Abdominal Pain - etiology; Adolescent; Anti-Inflammatory Agents - administration & dosage; Case Report; Duodenitis - drug therapy; Duodenitis - etiology; Female; Humans; Immunoglobulins, Intravenous - therapeutic use; Immunologic Factors - therapeutic use; Methylprednisolone - administration & dosage; Purpura, Schoenlein-Henoch - complications; Vasculitis - drug therapy
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-015-0545-4

Henoch-Schönlein purpura is an immunoglobulin A-mediated, small vascular inflammatory disease that can be associated with palpable purpura, arthralgia, abdominal pain, or nephritis. The presence of purpura facilitates the diagnosis of Henoch-Schönlein purpura at the onset of associated symptoms, whereas the absence of purpura makes the diagnosis challenging. It is important to diagnose Henoch-Schönlein purpura with delayed-onset skin purpura to avoid unnecessary surgery for acute abdomen. Most cases of Henoch-Schönlein purpura with severe abdominal pain are treated with low-dose steroids and intravenous immunoglobulin. A 15-year-old Korean girl complained of severe abdominal pain and delayed-onset purpura on admission. Henoch-Schönlein purpura was diagnosed based on endoscopic findings of hemorrhagic duodenitis and duodenal vasculitis and abdominal computed tomography findings of edematous bowels. Two common initial treatments, a low-dose steroid and intravenous immunoglobulin, were administered, but there was no improvement for 1 month. Subsequently, we used high-dose intravenous methylprednisolone pulse therapy (30 mg/kg/day, with a maximum of 1g/day), which dramatically alleviated her abdominal symptoms. High-dose intravenous methylprednisolone pulse therapy can be used as the ultimate treatment for delayed-onset Henoch-Schönlein purpura with severe abdominal pain when symptoms do not improve after low-dose steroid and intravenous immunoglobulin treatments.