Abstract
Case 1: A 57-year-old man was admitted to our hospital with polyarthritis, purpura and edema on both legs, and colicky abdominal pain with bloody diarrhea after common cold-like symptoms. A laboratory examination revealed nephrotic syndrome. He was diagnosed with HSP by skin and kidney biopsies. Treatment was initially started with prednisolone 50 mg/day intravenously. Although purpura on the lower extremities and polyarthritis partially improved after 2 weeks, his abdominal pain with melena worsened. Leukocytapheresis (LCAP) using Cellsorba E column was performed a total of 7 times twice a week. Intestinal bleeding with extrarenal symptoms disappeared after LCAP therapy. However, this therapy was not effective for edema and proteinuria; therefore, methylprednisolone pulse therapy was performed for 3 days, followed by oral prednisolone with cyclosporin. A significantly decrease was observed in proteinuria. Case 2: A 50-year old man was admitted to the Department of Dermatology of our hospital with arthralgia, a purpuric rash, and a submucosal abscess of the left inguinal region. He was diagnosed with HSP by skin biopsy, and a skin culture showed streptococcal infection; therefore, 30 mg/day of oral prednisolone was initiated. However, he suffered from colicky abdominal pain, melena, and edema with hematoproteinuria. He was referred to our division, and methylprednisolone pulse therapy was performed for 3 days after renal biopsy, followed by 50 mg/kg prednisolone intravenously. Although edema and proteinuria were markedly reduced, his abdominal pain and melena persisted. LCAP using Cellsorba E column was then performed a total of 3 times. Intestinal bleeding disappeared after LCAP therapy. In conclusion, we clarified the efficacy of LCAP therapy in 2 adult cases with HSP and severe extrarenal symptoms.
