Pulmonary hemorrhage associated with Henoch-Schöenlein purpura in an adult patient primary diagnosed of IgA nephropathy

CEN Case Reports
Takashi TaniShuichi Tsuruoka

Abstract

We describe a case of IgA nephropathy (IgAN) followed by pulmonary hemorrhage associated with Henoch-Schöenlein purpura (HSP) in an adult female. The patient had a history of renal insufficiency and persistent hematuria and proteinuria, without any extra-renal involvement. She was diagnosed with IgAN 7 years before the onset of HSP and had received immunosuppressive therapy for 6 years. One year after discontinuing oral prednisolone and mizoribine, she suffered a pulmonary hemorrhage. She presented with exacerbated urinary findings, and palpable purpura, resulting in the diagnosis of HSP. Intravenous pulse methylprednisolone followed by oral prednisolone (1 mg/kg/day) and a monthly intravenous cyclophosphamide pulse resolved the pulmonary hemorrhage. In a review of 36 HSP patients complicated with pulmonary hemorrhage, 27.8 % of the patients perished [Rajagopala et al., Semin Arthritis Rheum 42:391-400, 1]. While the most efficient therapeutic strategies for these patients have yet to be determined, we speculate that an aggressive therapy of pulse methylprednisolone combined with immunosuppression agents is likely to bring about the best outcome in cases with pathological conditions similar to our patient's. On the other hand, ...Continue Reading

References

Jan 1, 1985·The Journal of Pediatrics·S R Meadow, D G Scott
Oct 1, 1988·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·F J HughesP N McLaine
Jan 10, 2001·Current Opinion in Rheumatology·F T Saulsbury
Mar 27, 2007·Lancet·Frank T Saulsbury
May 22, 2008·Cleveland Clinic Journal of Medicine·Octavian C Ioachimescu, James K Stoller
Sep 16, 2009·Pediatrics and Neonatology·Shih-Pin HungBor-Luen Chiang
Sep 19, 2012·Seminars in Arthritis and Rheumatism·Srinivas RajagopalaIsha Garg

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Citations

Dec 24, 2018·BMJ Case Reports·Shinichi MiyazakiTakuya Ikeda

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