Schönlein-Henoch vasculitis in an adult

Abstract

[eng] A 60-year old man with medical history of dyslipidemia and gout presented with palpable purpura, haemorrhagic vesicles in the lowerlimbs (Fig. 1), small and large joint polyarthritis and abdominal pain without diarrhea. The cardiorespiratory and abdominal examinationswere normal, no fever or oxygen desaturation was observed. Initial blood analysis showed normal values except for leukocytosis of11.8 × 103/mm3with left shift and elevated C-reactive protein (12.73 mg/dl). Hemoglobin, platelets, coagulation, liver enzymes, renalfunction and ions were normal. The initial urine test presented proteinuria of 30 mg/dl. Chest X-ray showed a right pleural effusion.Blood cultures were negative and cardiac echocardiogram ruled out endocarditis. Human Immunodeficiency Virus, hepatitis B and C virus,Cytomegalovirus, Treponema pallidum, Varicella Zoster Virus, Erythrovirus B19, Bartonella quintina, Bartonella henselae, Coxiella burnetii,Chlamydophila pneumoniae and Mycoplasma pneumoniae serologies were negative. An autoimmunity study was performed (CH50, C3,CD, ANA, anticardiolipine, anti- 2GPI antibodies, ANCA, RF and cryoglobulins) with negative results. The anatomopathological result ofskin biopsy showed a small vase vasculitis with IgA deposits (Fig. 2) that confirmed the suspition of Schönlein-Henoch disease. Due tothe deterioration of the renal function, a daily dose of 40 mg of prednisone was given, with resolution of the symptoms and analyticalalterations.