Year 2023 / Volume 115 / Number 10
Letter
Henoch-Schönlein purpura masquerading as Crohn’s disease flare

581

DOI: 10.17235/reed.2022.9414/2022

Cristiana Sequeira, Inês Santos, Sara Lopes, Cristina Teixeira, João Mangualde, Ana Paula Oliveira,

Abstract
We describe the case of a 69-year-old male with Crohn's disease (CD), treated with infliximab and undergoing intestinal resection. The surgery and postoperative period were unremarkable, with no CD-related symptoms. Two months after surgery and two weeks after the introduction of infliximab, he was admitted due to acute onset diffuse abdominal pain, hematochezia and arthralgia. On physical observation on admission, he showed signs of arthritis of the left knee. Laboratory tests revealed renal failure with nephrotic proteinuria, slightly low complement (C3) and IgA elevation. Remaining autoimmunity and viral panel were negative. Abdominal examination showed duodenum and thickening of the proximal wall of the jejunum. Biopsies excluded active CD. Colon and ileum mucosa were normal. The patient met EULAR criteria for Henoch-Schönlein purpura and was started on prednisolone with response. Although no clear trigger was pointed out, we switched anti-TNF to ustekinumab. We present this case given its endoscopic exuberance, and because of the high index of suspicion to make the diagnosis in adult patients with previous inflammatory bowel disease. The distinction between this vasculitis and CD is of utmost importance, given the therapeutic implications.
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References
1. Ruperto N, Ozen S, Pistorio A et al EULAR/PRINTO/PRES criteria for Henoch-Schönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part I: Overall methodology and clinical characterisation. Ann Rheum Dis. 2010 May;69(5):790-7. doi: 10.1136/ard.2009.116624. Epub 2010 Apr 13. Erratum in: Ann Rheum Dis. 2011 Feb;70(2):397.
2. Pinheiro RR, Lencastre A. Henoch-Schönlein purpura during anti-TNFα therapy: a fortuitous event or an indication to stop therapy? Eur J Dermatol. 2017 Jun 1;27(3):304-305. doi: 10.1684/ejd.2017.2979. PMID: 28468732.
3. Stampa Ferro J, Fernández González B, Arzallus Marco T, Izagirre Arostegi A, Azcue Prieto B, Cavero Barreras L, Segués Merino NM, Alonso-Galán H. IgA vasculitis (Henoch- Schönlein purpura) with gastrointestinal involvement. Rev Esp Enferm Dig. 2022 Nov 25. doi: 10.17235/reed.2022.9329/2022. Epub ahead of print. PMID: 36426858.
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Sequeira C, Santos I, Lopes S, Teixeira C, Mangualde J, Oliveira A, et all. Henoch-Schönlein purpura masquerading as Crohn’s disease flare. 9414/2022


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Publication history

Received: 08/12/2022

Accepted: 15/12/2022

Online First: 23/12/2022

Published: 09/10/2023

Article Online First time: 15 days

Article editing time: 305 days


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