Published online Jul 14, 2016. doi: 10.3748/wjg.v22.i26.6089
Peer-review started: March 29, 2016
First decision: April 14, 2016
Revised: May 7, 2016
Accepted: May 21, 2016
Article in press: May 23, 2016
Published online: July 14, 2016
Processing time: 100 Days and 2.1 Hours
Henoch-Schönlein purpura (HSP) is generally a self-limited vasculitis disease and has a good prognosis. We report a 4-year-old Thai boy who presented with palpable purpura, abdominal colicky pain, seizure, and eventually developed intestinal ischemia and perforation despite adequate treatment, including corticosteroid and intravenous immunoglobulin therapy. Imaging modalities, including ultrasonography and contrast-enhanced computed tomography, could not detect intestinal ischemia prior to perforation. In this patient, we also postulated that vasculitis-induced mucosal ischemia was a cause of the ulcer, leading to intestinal perforation, and high-dose corticosteroid could have been a contributing factor since the histopathology revealed depletion of lymphoid follicles. Intestinal perforation in HSP is rare, but life-threatening. Close monitoring and thorough clinical evaluation are essential to detect bowel ischemia before perforation, particularly in HSP patients who have hematochezia, persistent localized abdominal tenderness and guarding. In highly suspicious cases, exploratory laparotomy may be needed for the definite diagnosis and prevention of further complications.
Core tip: Henoch-Schönlein purpura (HSP) with intestinal perforation during the course of corticosteroid treatment was a rare condition. We report a HSP patient with vasculitis-induced mucosal ischemia, eventually leading to ulcer and intestinal perforation. No imaging modality could detect bowel ischemia before perforation. Histopathology of resected bowel also suggested that high-dose corticosteroids might be a contributing factor to intestinal perforation in this patient. Early treatment by surgical resection of ischemic bowel can prevent intestinal perforation and peritonitis, which are life-threatening complications.