Clinical Endoscopy

A Case of Henoch-Schönlein Purpura Involving Colon Mimicking Colon Cancer: Seung Hoon Park, M.D., Jin-Oh Kim, M.D., Hyun Gun Kim, M.D., Tae Hee Lee, M.D., Wan Jung Kim, M.D., Sung Wook Hong, M.D., Sung Gon Jun, M.D. and So Young Jin, M.D.^*; Korean J Gastrointest Endosc 2011;42(5):306-310. Published online May 28, 2011

Abstract PDF: Henoch-Schönlein purpura is the most common form of systemic vasculitis in children but occurs rarely in adults. Henoch-Schönlein purpura has characteristic features of a purpuric skin rash, abdominal pain, arthralgia, and abnormal urinary findings. Gastrointestinal tract involvement is characterized by abdominal pain and gastrointestinal bleeding. Recently, we experienced a case of Henoch-Schönlein purpura with gastrointestinal involvement mimicking colon cancer in a 41-year-old female who complained of erythematous macules, arthralgia, and abdominal pain. The initial colonoscopic findings and computed tomographs failed to rule out colon cancer, but serial endoscopic examinations and clinical manifestations revealed colonic involvement of Henoch-Schönlein purpura. (Korean J Gastrointest Endosc 2011;42:306-310)

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Cytomegalovirus Colitis in an Immunocompetent Patient with Henoch-SchoҨnlein Purpura: Jung Yoon Yoon, M.D., Sung-Ae Jung, M.D., Hyun Joo Song, M.D., Min-Jung Kang, M.D., Seong-Eun Kim, M.D., Ki-Nam Shim, M.D., Kwon Yoo, M.D. and Dong Eun Song, M.D.*; Korean J Gastrointest Endosc 2009;39(3):176-180. Published online September 30, 2009

Abstract PDF: Most cases of cytomegalovirus (CMV) colitis occur in adults with severe immuno- deficiency. There have been a few reports involving immunocompetent patients. CMV colitis may occur after colonic mucosal injury in immunocompetent patients. Henoch-SchoҨnlein purpura (HSP) is a common systemic vasculitis in childhood. Diagnostic criteria include palpable purpura with at least one other manifestation; abdominal pain, IgA deposition, arthritis or arthralgia, or renal involvement. To best of our knowledge, we describe the first case of CMV colitis in an immunocompetent patient with preceding HSP. A 38-year-old man presented with a 1-day history of abdominal pain, diarrhea and vomiting. Two-years previously, he underwent a right hemicolectomy due to intussusception. Over a 1-month period, palpable purpura was evident on both arms and legs. Colonoscopy revealed multiple, linear geographic ulcerations at an anastomosis opening site with huge ulceration at the small bowel, which was covered with white exudates. Colonoscopic biopsy showed CMV inclusion bodies and skin biopsy revealed leukocytoclastic vasculitis. The patient was successfully treated with gancyclovir and prednisolone. (Korean J Gastrointest Endosc 2009;39:176-180)

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A Case of Henoch-Schönlein Purpura with Cerebellar and Gastrointestinal Bleeding: Hyun Seok Lee, M.D., Young Sook Park, M.D., Kye Hyoung Kwon, M.D., Chung Hyeon Kim, M.D., Won Wook Choi, M.D., Tae Hun Kim, M.D., Yeon Ho Choo, M.D., Yun Ju Jo, M.D., Seung Jin Lee, M.D.* and Jong Eun Ju, M.D.^†; Korean J Gastrointest Endosc 2005;30(2):86-90. Published online February 27, 2005

Abstract PDF: Henoch-Schönlein purpura is a systemic leukocytoclastic vasculitis involving small vessels. The diagnostic criteria is defined as a typical skin rash of which pathologic examination shows leukocytoclastic vasculitis, accompanied by any two of these major manifestations of the disease, namely gastrointestinal tract, kidney, joint involvement. In elder patient, Henoch-Schönlein purpura shows more serious gastrointestinal tract involvement. There are some reports of brain involvement of Henoch-Schönlein purpura. A 69-year-old man was admitted to department of neurosurgery, because of loss of consciousness. Brain CT showed acute cerebellar hemorrhage with rapid resolution by conservative treatment. Diffuse purpuric eruptions on both low legs were developed after 7 days of hospitalization. He was refered to our department due to epigastric pain and bloody diarrhea. There were multiple longitudinal ulcers with hemorrhage on the stomach and the sigmoid colon of which biopsy showed leukocytoclastic vasculitis. Microscopic hematuria and proteinuria were also noted. He had a fatal course due to recurrent colonic bleeding and poor medical condition. We report an unusual case of cerebellar and gastrointestinal involvement of Henoch-Schönlein purpura in elderly patient. (Korean J Gastrointest Endosc 2005;30:86⁣90)

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A Case of Henoch-Schönlein Purpura Associated with Gastric Ulcer Bleeding: Eun Jung Kim, M.D., Woo-Chul Chung, M.D., Kang Moon Lee, M.D., Jin Sun Lee, M.D., U-Im Chang, M.D., Hyun Mi Cho, M.D., Jin Mo Yang, M.D., Sung Kyoung Kim, M.D.,Jong Myoung Nah, M.D. and In Sik Chung, M.D.; Korean J Gastrointest Endosc 2004;29(4):199-203. Published online October 30, 2004

Abstract PDF: Henoch-Schönlein purpura is a systemic leukoclastic vasculitis that predominantly affects small vessels. This results in purpura, abdominal pain, arthralgia and occasional sometimes nephritis. Gastrointestinal involvement occurs in 50∼75% of the patients. The small bowel and colon are relatively commonly affected, but the gastric involvement is rare. Endoscopic findings include mucosal edema, hemorrhagic changes, erosions and superficial ulcers. However, deep gastric ulcers are rarely observed in Henoch-Schönlein purpura and have not been reported yet. We report a patient with typical Henoch-Schönlein purpura who presented with melena due to bleeding from multiple deep gastric ulcers and got improved with administration of high dose corticosteroid. (Korean J Gastrointest Endosc 2004;29:199⁣203)

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A Case of Henoch-Schönlein Purpura with Duodenal Involvement: Su Jin Yoon, M.D., Ki-Nam Shim, M.D., Moon Sun Yeoum, M.D., Ji Young Park, M.D., Myung Shin Kim, M.D., Hee Jung Choi, M.D., Sung-Ae Jung, M.D., Kwoon Yoo. and Il-Hwan Moon, M.D.; Korean J Gastrointest Endosc 2004;29(3):151-155. Published online September 30, 2004

Abstract PDF: Henoch-Schönlein purpura is a form of systemic small- vessel vasculitis characterized by vascular purpura, predominantly occured on the lower limbs and articules with gastrointestinal and renal symptoms. The symptoms occur consecutively and purpura is the most common initial manifestation but if another symptoms prevails, the diagnosis often can be delayed. Any portion of the gastrointestinal tract distal to the esophagus may be involved, but most frequently affected sites are jejunum and ileum. Mucosal lesions found predominantly in the second portion of the duodenum seem to be characteristic of Henoch-Schönlein purpura and may assist the diagnosis in patients with atypical nonspecific symptoms. We report a case of Henoch-Schönlein purpura with the characteristic endoscopic finding in the second portion of duodenum, which helps to make the correct diagnosis and proper management of the patient. (Korean J Gastrointest Endosc 2004;29:151⁣155)

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A Case of Henoch-Schönlein Purpura with Small Bowel Hemorrhage Diagnosed by Capsule Endoscopy: Gun Wha Lee, M.D., Young Koog Cheon, M.D., Hyun Jeong Kim, M.D.,Sang Ho Lee, M.D., Joo Young Cho, M.D. and Chan Sup Shim, M.D.; Korean J Gastrointest Endosc 2004;28(6):317-320. Published online June 30, 2004

Abstract PDF: A 23 year-old female patient complained of recurrent abdominal cramps and underwent emergency appendectomy in a private clinic. Two weeks later, she complained of lower GI bleeding and was referred to our hospital. On admission, she had abdominal pain and arthralgia but no hematuria. On physical examination, she was hemodynamically stable but was pale. There was no specific finding in laboratory test, except slightly lower level of blood hemoglobin. EGD revealed no specific findings. Colonoscopy showed fresh blood in the colon with small ulcers and erosions in the ileocecal valve but no source of active bleeding. On third admission day, she developed palpable macular rash initially over her lower legs, ankles, wrist joints and later on anterior abdominal wall. Capsule endoscopy revealed several small and large ulcers and erosions in the entire small bowel with blood clots. She was diagnosed clinically as a case of Henoch-Schönlein purpura through her clinical history and skin lesions. She was administered prednisolone 40 mg/day for a period of one week. Her symptoms, G-I bleeding as well as the skin lesions responded well to steroid therapy and she remained asymptomatic afterwards. (Korean J Gastrointest Endosc 2004; 28:317⁣320)

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Henoch-Schönlein Purpura in a Disseminated Tuberculosis Patient: Dae Hyung Jun, M.D., Byung Wook Kim, M.D., Bo In Lee, M.D., Yong Bum Park, M.D.,; Korean J Gastrointest Endosc 2003;26(1):35-38. Published online January 30, 2003

Abstract PDF: Henoch-Schönlein purpura is a systemic leukoclastic vasculitis and involves small vessels resulting in vasculitis. Major pathogenetic mechanism of Henoch-Schönlein purpura has not been still elucidated. Possible causes, however, may be associated with viral infection, bacterial infection, exposure to drugs and toxins, systemic diseases and carcinomas. Henoch-Schönlein purpura rarely develops in patients with tuberculosis, though there have been some reports on the development of this syndrome during antituberculous therapy. A 24-year-old man was admitted to our hospital because of diffuse abdominal pain, lower leg purpura and disseminated tuberculosis involving lung, duodenum, colon and lumbar spine and diagnosed as Henoch-Schönlein purpura with disseminated tuberculosis. Henoch-Schönlein purpura developed before antibuberculous therapy and antituberculous treatment was effective both in disseminated tuberculosis and Henoch-Schönlein purpura. We concluded that disseminated
tuberculosis might be a cause of Henoch-Schönlein purpura. (Korean J Gastrointest Endosc 2003;26:35⁣38)

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위장관 출혈이 합병된 Henoch-Sch nlein 자반증 2예 ( Two Cases of Henoch-Sch nlein Purpura Complicated by Gastrointestinal Bleeding ): Korean J Gastrointest Endosc 1999;19(5):803-807. Published online November 30, 1998

Abstract PDF: In the course of Henoch-Sch nlein purpura, diverse gastrointestinal manifestations are common. Two cases of Henoch-Sch nlein purpura complicated by upper and lower gastrointestinal bleeding is herein reported. For both patients, peculiar endoscopic pictures revealed, severe ulcerations and frank bleeding. A biopsy showed typical leukocytoclastic vasculitis which were the same as with the skin biopsy. The endoscopic finding was determined not to be pathognomonic, but instead characteristic of Henoch-Sch nlein purpura. Therefore, an endoscopy can be useful in the diagnosis of Henoch-Sch nlein purpura, especially for those patients without a typical skin rash. (Korean J Gastrointest Endosc 19: 803∼807, 1999)

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증례 : 식도 위장관 ; 십이지장을 침범한 Henoch - Shoenlein Purpura 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Henoch - Shoenlein Purpura with Duodenal Involvement ): Korean J Gastrointest Endosc 1996;16(4):639-643. Published online November 30, 1995

Abstract PDF: Henoch-Shonlein(H-S) purpura, or anaphylactoid purpura is a hypersensitivity vasculitis characterized by palpable purpura usually on buttock and low extremities; arthralgia mostly polyarhtralgia in the absence of frank arthritis; gastraintestinal involvement with colicky abdominal pain, nausea, vomiting, diarrhea, constipation and bleeding; and renal involvement, manifested chiefly by hematuria and proteinuria. Gastrointestinal involvement is seen in 70 percent of pediatric patients and one third of adult patients. Any portion of the gastrointestinal tract distal to the esophagus maybe involved, but most frequently affected sites are jejunum and ileum. We report one case of H-S purpura with duodenal involvement observed in 16, male patient. (Korean J Gastrointest Endosc 16: 639~649, 1996)

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증례 : 식도 위장관 ; 장관을 침범한 Henoch - Schoenlein Purpura 1예 ( Case Reports : Esophagus , Stomach & Intestine ; A Case of Henoch - Schoenlein Purpura Involving G-I Tract ): Korean J Gastrointest Endosc 1996;16(1):94-101. Published online November 30, 1995

Abstract PDF: Henoch-Schonlein purpura or Anaphylactiod purpura is rare syndrome in adults characterized by a symmetrical, non traumatic, nonthrombocytopenic, painless purpuric rash, arthritis, nephritis, gastrointestinal manifestation. G-I tract involvement is characterized by abdominal pain, G-I bleeding. Although the small bowel is more frequently involved, cases of esophageal, gastroduodenal and colorectal localization have been rarely reported. Recently, we have experienced a case of Henoch-schonlein purpura with renal, skin, extensive gastrointestinal involvement in a 53 year-old male patient who complained of pain, purpura, generalized abdominal pain, dyspnea. The endoscopic findings of duodenum and colon in a patient with Henoch-Schonlein purpura are presented. (Kor J Gastrointest Endosc 18: 94-99, 1996)

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상부위장관을 침범한 H-S Purpura 1예 ( A Case of Henoch - Schoenlein Purpura Involving upper GI Tract ): Korean J Gastrointest Endosc 1992;12(2):231-235. Published online November 30, 1991

Abstract PDF: Henoch-Schonlein purpura(anaphylactoid purpura) is a necrotizing vasculitis of small vessels in which systemic manifestation include palpable purpura on the lower extremities and buttocks due to leukocytoclastic vasculitis of dermal vessels; arthralgia of large joints, usually the knees and ankles; gastronitestinal involvement with colic and bleeding; and renal ievolvement, usually with a focal necrotizing glomerulonephritis. Gastrointestinal involvement occurs in about two thirds of all pediatric cases and in about,one third of adult cases, Any bowel segment may be involved, but the jejunum and ileum are most frequently affected. With a brief review of the literature, we report a case of H-S purpura involving stomach and duodenum.

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