Preliminary communication
Henoch-Schönlein Purpura Complicated by Appendicitis, Intussusception and Ureteritis
Mladen Jašić
Mirna Šubat-Dežulović
Harry Nikolić
Nives Jonjić
Koraljka Manestar
Matko Dežulović
Abstract
Henoch-Schönlein purpura (HSP) is the most common childhood systemic small-vessel vasculitis with skin, joint,
gastrointestinal (GI) and renal involvement. Uncommon GI complications are intussusception, bowel perforation and
rarely reported appendicitis. HSP-associated stenosing ureteritis represents a rare and potentially serious complication.
We present a 5-year-old boy with severe and prolonged course of HSP and three very rare complications that occurred sequentially:
appendicitis, intussusception and ureteritis. Only three days after admission, he developed clinical signs of
acute appendicitis indicating surgical intervention. Histological analysis of excised appendix showed inflammation but
without signs typical for vasculitis. Two weeks later, with the reccurence of HSP, he again developed clinical picture of
acute abdomen. Ultrasound and radiologic evaluation demostrated ileo-ileal intussusception and the second laparotomy
was undertaken. Histological analysis of the resected bowel tissue showed typical signs of leucocytoclastic vasculitis. In
the fourth week of his illness, serial urinalysis showed nephritic urinary sediment indicative of renal invovement. Unexpectedly,
control abdominal ultrasound demostrated mild hydronephrosis of the left kidney, not seen on previous ultrasound
evaluations. Undertaken excretory urography and computed tomography (CT) scan showed stenosis of upper/
midureter with mild dilation of upper part of the left ureter sugesting unilateral HSP-associated stenosing ureteritis.
Eventually, the patient was discharged and closely followed-up for the next two years. He had no further reccurence of
HSP, the urinalysis normalized after six months, while mild unilateral hydronephrosis remained unchanged. Our
search of the literature did not show reports of HSP complicated by appendicitis, intussusception and ureteritis, and to
our knowledge this is the first case with three different illness events that occured sequentially. We emphasize the necessity
of repeated ultrasound evaluations in the course of HSP, especially in cases with severe GI and renal invovement.
Keywords
Henoch-Schönlein purpura; appendicitis; intussusception; ureteritis
Hrčak ID:
64784
URI
Publication date:
7.3.2011.
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