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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 intestinal Henoch-Schonlein purpura with response to intravenous immunoglobulin infusion

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 Henoch-Schonlein 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 9-year-old girl who presented acutely with life-threatening gastrointestinal haemorrhage from multiple intestinal sites, with no skin rash and only mild evidence of renal involvement. Henoch-Schonlein 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 corticosteroid-resistant cases to suggest that severe intestinal Henoch-Schonlein 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 first-line therapy.


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Other Papers In This Journal:

  1. Massive gastrointestinal haemorrhage in isolated intestinal Henoch-Schonlein purpura with response to intravenous immunoglobulin infusion
  2. Reversible posterior encephalopathy syndrome associated with micronodular adrenocortical disease and Cushing syndrome
  3. Auto-immune pancytopenia in a child with DiGeorge syndrome
  4. Effective parenteral clodronate treatment of a child with severe juvenile idiopathic osteoporosis
  5. Evaluation of the Omron MX3 Plus monitor for blood pressure measurement in adolescents
  6. Paroxetine during breast-feeding: infant weight gain and maternal adherence to counsel
  7. Characteristics of the menstrual cycle in 13-year-old Flemish girls and the impact of menstrual symptoms on social life
  8. Proportional assist versus assist control ventilation in premature infants
  9. Thrombus obstructing the right ventricle outflow tract in a neonate with methylenetetrahydrofolate reductase 677TT genotype
  10. Eosinophilic tubulointerstitial nephritis on treatment with isotretinoin
  11. A European Society of Paediatric and Neonatal Intensive Care (ESPNIC) survey of European critical care management of young people
  12. Clinical practice
  13. Parameters affecting length of stay in a pediatric emergency department: a retrospective observational study
  14. Clustering of (auto)immune diseases with early-onset and complicated inflammatory bowel disease
  15. Risk factors for ventilator-associated pneumonia in the neonatal intensive care unit: a meta-analysis of observational studies
  16. Onset of acquired autoimmune hypothyroidism in infancy: a presentation of delayed gross-motor development and rhabdomyolysis
  17. Unusual clinical presentation of primary hypothyroidism in a very young infant caused by autoimmune thyroiditis: case report and update of the literature
  18. A quality improvement initiative to reduce central line infection in neonates using checklists
  19. Cognition and the risk of eating disorders in Spanish adolescents: the AVENA and AFINOS studies
  20. Transient antiphospholipid antibodies associated with acute infections in children: a report of three cases and a review of the literature
  21. Eosinophilic tubulointerstitial nephritis on treatment with isotretinoin

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