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Title of Journal: Eur J Pediatr

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Abbravation: European Journal of Pediatrics

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Springer-Verlag

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1432-1076

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Massive gastrointestinal haemorrhage in isolated i

Authors: Andrew A O Fagbemi Franco Torrente Andrew J W Hilson Michael A Thomson Robert B Heuschkel Simon H Murch
Publish Date: 2006/11/21
Volume: 166, Issue: 9, Pages: 915-919
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Abstract

There is increasing recognition that HenochSchonlein purpura may present in an atypical form in which gastrointestinal symptoms may predominate and classic cutaneous changes may be delayed or absent This may lead to significant diagnostic delay We report the case of a 9yearold girl who presented acutely with lifethreatening gastrointestinal haemorrhage from multiple intestinal sites with no skin rash and only mild evidence of renal involvement HenochSchonlein purpura was confirmed by finding IgA deposition on vessels within gastric and duodenal mucosa while immunohistochemistry also identified dense focal T cell infiltration in gastric mucosa and within duodenal epithelium After initial stabilisation the patient became shocked due to further gastrointestinal haemorrhage Isotope bleeding scan identified multiple bleeding sites Her endoscopically confirmed gastritis was sufficiently severe to preclude corticosteroids and she was thus treated with intravenous immunoglobulin This therapy induced prompt and sustained resolution of symptoms and she has remained well since Our patient’s response concords with previous reports in corticosteroidresistant cases to suggest that severe intestinal HenochSchonlein purpura may respond preferentially to intravenous immunoglobulin IVIG therapy In severe cases where there is significant gastritis IVIG provides an effective alternative to corticosteroids that may be employed as firstline therapy

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