Abstract :
We reported the gastrointestinal (GI) endoscopic findings in a 12-year-old boy with Henoch-Schonlein
purpura (HSP). The patient presented with massive rectal bleeding and abdominal pain, requiring multiple blood
transfusions. The colonoscopic examination revealed colonic lymphonodular hyperplasia with mild mucosal
erythema. The biopsies showed erosive colitis with vascular fibrinoid necrosis. Capsule endoscopy, performed 10
days after cessation of the bleeding, demonstrated petechial-like lesions on the gastric mucosa and mucosal inflam-
mation in the terminal ileum. Although, there was no skin involvement, the patient was diagnosed as HSP on the
basis of GI bleeding and the age less than 20 years old, using the criteria of the American College of Rheumatology
1990. The diagnosis was further supported by the evidence of vascular fibrinoid necrosis in the colonic biopsy,
intermittent clinical history, clinical response to steroid therapy during the first admission, and extensive exclusion
of possible significant patholgy, using panendosocpy, capsule endoscopy, upper GI study, angiography, and even
surgery. He has been closely monitored for the recurrent symptoms, in which steroid therapy is planned.
Key words : Gastrointestinal bleeding, vasculitis, pathology, endoscopy, Henoch-Schonlein purpura, diagnosis
[Thai J Gastroenterol 2004; 5(1):62-66] |
file/Thai-Journal-of-gastroenterology-vol-5-no-1-1147313.pdf