Severe Henoch-Schonlein Purpura with Intestinal Hemorrhagic Ulcers : Treated by Steroid Pulse Therapy : Case Reports

Abstract: Henoch-Schonlein purpura, associated with severe duodenal hemorrhage and gastrointestinal dysfunction, was dramatically suppressed by steroid pulse therapy. A 22-year-old male was admitted with abdominal pain, purpuric rash, and neutrophilic leukocytosis. C-reactive protein was increased and coagulation Factor XIII was markedly decreased. Upper gastrointestinal endoscopy disclosed multiple ulcers and erythema with petechiae in the postbulbar duodenum. Based on laboratory findings including examination of a skin biopsy specimen, this patient was diagnosed as having Henoch-Schonlein purpura. Despite aggressive administration of prednisolone, intravenous hyperalimentation, and Factor XIII concentrate, symptoms worsened. Steroid pulse therapy was then given for three days, resulting in amelioration of all clinical findings. The duodenal ulcers showed scarring on endoscopy. Gastrointestinal complications of Henoch-Schonlein purpura. Factor XIII concentrate therapy, and pulse steroid therapy are discussed herein.