Two Cases of Schönlein-Henoch Purpura with Multiple Ulcers in the Second Portion of the Duodeum

Abstract

A 42-year old man and a 26-year old man suffered from both numerous red papules and purpura on their lower extrimities and severe abdominal pain. In both cases, endoscopic examination revealed marked multiple ulcers in the second portion of the duodeum. A histopathological examination of the skin lesions showed leukocytoclastic vasculitis. Both cases were diagnosed to be Schönlein-Henoch purpura with duodenal ulcers. The administration of high dose of predonisolone (80mg/day) in the first case and steroid pulse therapy (solmedrol 1g/day for three days) in the second case resulted in improvement of both clinical symptoms and findings of duodenal ulcers. The second portion of the duodeum is a rare location for peptic ulcers, but this location has been reported in eighty percent of all Schönlein-Henoch purpura cases over the past fifteen years in Japan. As a result, it may be highly characteristic for the intestinal involvement of Schönlein-Henoch purpura. We therefore recommend that patients with Schönlein-Henoch purpura and severe abdominal symptoms should undergo endoscopic examination and also be treated with a high dose of corticosteroids in the early stage of the disease.