Abstract
Schonlein-Henoch purpura occurs most commonly in children and rarely in adults. The entity of the abdominal lesions remains uncertain. This report is the presentation of a case of Schonlein-Henoch purpura with a statistic analysis of 28 adult cases examined by upper gastrointestinal endoscopy in Japan and some considerations about the etiology of the gastrointestinal involvement in this disease. A 52-year-old man noted the onset of purpura with systemic arthralgia and macroscopic hematuria. After 2 weeks, he suffered from severe hematemesis, melena, vomiting and abdominal pain. Endoscopic examination revealed spotty bleeding and erosions in the stomach, and duodenal ulcer. After taking H2 -receptor antagonist and adrenocortical steroid, his subjective symptoms and endoscopic findings prominently improved. The deposition of IgA positive substance at the wall of small vessels was seen by using enzyme-labelled antibody technique. The degranulation of masf cells was observed by electron microscopy. This degranulation was considered to be caused by the antigen-IgA immune complexes. These mechanisms were considered to be increasing the vascular permeability and to be involving the gastrointestinal lesions in this disease. It was suggested that the action of H2-receptor antagonist and adrenocortical steroid, inhibitting the increase in vascular permeability, was effective to these mechanisms.
