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Open Access Case Report

An adult patient with Henoch-Schönlein purpura and non-occlusive mesenteric ischemia

Chiyako Oshikata1, Naomi Tsurikisawa1*, Masakazu Takigawa2, Tomoko Omori2, Satoshi Sugano3, Takahiro Tsuburai1, Hiroyuki Mitomi4, Tamiko Takemura5 and Kazuo Akiyama1

Author Affiliations

1 Department of Allergy and Respirology, National Hospital Organization Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara, Kanagawa 252-0392, Japan

2 Department of Radiology, National Hospital Organization Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara, Kanagawa 252-0392, Japan

3 Department of Gastroenterology, National Hospital Organization Sagamihara National Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara, Kanagawa 252-0392, Japan

4 Department of Human Pathology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

5 Department of Pathology, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan

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BMC Research Notes 2013, 6:26  doi:10.1186/1756-0500-6-26

Published: 23 January 2013

Abstract

Background

Onset of Henoch-Schönlein purpura (HSP) in middle age is uncommon, and adults with renal or gastrointestinal involvement present with more severe disease than do similar pediatric patients.

Case presentation

We present the case of a 69-year-old male with HSP who, after treatment with steroids, cyclophosphamide, and continuous intravenous prostaglandin E1 (PGE1), died as a result of severe gastrointestinal involvement with non-occlusive mesenteric ischemia (NOMI). Vascular narrowing associated with the NOMI improved after catheter injection of PGE1 and prednisolone, but the patient died of bleeding from an exposed small vessel. At autopsy there was no active vasculitis in the jejunal submucosa.

Conclusion

Treatment with PGE1 and prednisolone might improve small-vessel vasculitis associated with NOMI.

Keywords:
Henoch-Schönlein purpura; Intervention; Non-occlusive mesenteric ischemia; Small vessel vasculitis