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A Case of Henoch Schönlein Purpura with Gastrointestinal Bleeding Due to Jejunal Ulcer by Capsule Endoscopy

Article information

Kosin Med J. 2012;27(1):45-49
Publication date (electronic) : 2012 June 11
doi : https://doi.org/10.7180/kmj.2012.27.1.45
Yong Kang Lee1, Tak Keun Oh1, Ara Choi1, Ji Hoon Lee1, Mi Na Kim1, Sung Pil Hong1,2
1Department of Internal Medicine, College of Medicine, Yonsei University, Seoul, Korea.
2Division of Gastroenterology, College of Medicine, Yonsei University, Seoul, Korea.
Corresponding Author: Sung Pil Hong, Department of Internal Medicine, College of Medicine, Yonsei University, 250 Seongsanno, Seodaemun-gu, Seoul 120-752, Korea. TEL: 010-8940-5775, FAX: 02) 393-6884, sphong@yuhs.ac
Received 2011 September 28; Revised 2011 November 09; Accepted 2011 November 28.

Abstract

Henoch-Schönlein purpura (HSP) is the most common form of systemic vasculitis in children. Palpable purpura, arthralgia, arthritis, abdominal pain and renal involvement are the major clinical manifestations. Gastrointestinal involvement is related with abdominal pain and bleeding.

We described a 71 year-old female experienced acute exacerbation of HSP presented with gastrointestinal bleeding. She was hospitalized for hematemesis and diagnosed duodenitis by esophagogastroduonenoscopy (EGD). Duodenitis was improved at EGD checked in 7 days. She still complained of melena and abdominal pain. There were no abnormal findings at sigmoidoscopy. Jejunal ulcer and purpura were diagnosed by capsule endoscopy. Symptoms were relieved after administration of systemic steroid. But she needed renal replacement therapy for 3 months.

Small bowel ulcer diagnosed by capsule endoscopy in patients with HSP was rarely described in Korean literature. This case suggests that capsule endoscopy have a role in diagnosis of small bowel ulcer and its severity in HSP with gastrointestinal symptom.

Keywords: Capsule endoscopy; Gastrointestinal hemorrhage; Henoch-Schönlein pupura

References

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Copyright © 2012 Kosin University College of Medicine

Fig. 1

Fig. 1

Esophagogastroduodenoscopy (EGD) findings. (A) EGD showed mild chronic superficial gastritis (B) EGD showed severe duodenitis from bulb to 2nd portion of duodenum.

Fig. 2

Fig. 2

Capsule endoscopy showed multiple ulcer and erosions, multiple erythematous lesion and ulcer at Jejunum

Fig. 3

Fig. 3

Light microscopic finding of skin biopsy taken outpatients clinic before 3 years ago. They show leukocytoclastic vasculitis. (A) HE stain × 40HE (B) stain × 200

Fig. 4

Fig. 4

light microscopic finding of renal biopsy. (A) glomeruli show global sclerosis. And tubular atrophy was seen (B) glomeruli associated with fibrocellular/cellular crescents. The glomerular basement membrane is not thickened