Abstract
Henoch-Schönlein purpura (HSP) is characterized by systemic leukocytoclastic vasculitis of small vessels, while medium-sized vessels can rarely be involved. Clinical manifestations usually include palpable purpura, arthralgia, nephritis and abdominal pain. HSP occurs commonly in children between 3 and 15 years old, while rather rarely in adults. A 58-year old man was referred to our hospital because of complaining of epigastric pain and high grade fever. Since an abdominal CT scan showed a wedge-shaped area of contrast defect in the renal parenchyma on both sides, he was hospitalized on suspicion of pyelonephritis. However, during hospitalization, he developed severe epigastric pain, purpura of both lower extremities and,-polyarthritis. A skin biopsy was performed. The pathological result showed the presence of leukocytoclastic vasculitis. Therefore, he was diagnosed with HSP. A follow-up abdominal CT scan revealed a high density area consistent with the previous failure of bilateral renal parenchyma contrast, suggesting renal hemorrhagic infarction. After 40 mg of prednisolone was administered intravenously once daily, abdominal and joint pain rapidly improved. Purpura of both extremities and the abnormal findings of CT scan diminished. We here report a rare adult case of HSP complicated with involvement of medium-sized vessels, which resulted in hemorrhagic renal infraction. It seems that it will be necessary to accumulate further cases of HSP complicated with mediumsized vessel involvement.
