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Adult Henoch-Schönlein Purpura With Fatal Complications
Rebecca McCarthy, MD;
Ted Rosen, MD;
San-Hwan Chen, MD;
Sharon S. Raimer, MD
Arch Dermatol. 2001;137:19-21.
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REPORT OF 2 CASES
CASE 1
A 63-year-old man with a history of diabetes, hypertension, depression, and stroke presented with a 1-week history of diarrhea, nausea, arthralgia, and acral purpuric eruption as well as progressively increasing abdominal pain. On examination he was noted to have palpable purpura on his hands and feet (Figure 1), bloody stool, and abdominal distention. Petechial hemorrhages throughout the small bowel were discovered on exploratory laparotomy. Laboratory findings revealed hematuria, elevated serum urea nitrogen and creatinine levels, and an increased sedimentation rate. Skin biopsy results showed a leukocytoclastic vasculitis and granular deposition of IgA (Figure 2), IgM, and C3 in capillaries consistent with Henoch-Schönlein purpura (HSP). Test results for antinuclear antibodies, antineutrophil cytoplasmic antibodies, viral hepatitis, cryoglobulins, and cryofibrinogens were all negative.
Figure appears in full text version.
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Figure 1. Palpable purpura on the foot of patient 1.
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Figure appears in full text version.
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CASE 2
DIAGNOSTIC CHALLENGE
COMMENT
From the University of Texas Medical Branch, Galveston (Drs McCarthy, Chen, and Raimer); Baylor College of Medicine, Houston, Tex (Dr Rosen).
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