Elena Toader, PhD, Mirela Piscuc, MD, Andreea-Luiza Palamaru, MD St. Spiridon Hospital, Iasi, Iasi, Romania
Introduction: Henoch–Schönlein purpura (HSP), is a self-limiting vasculitis involving the small vessels of the skin, gastrointestinal tract, kidneys, joints, and rarely the lungs and central nervous system (CNS). The severe acute respiratory syndrome coronavirus-2 (Sars-CoV-2) infection may be a condition associated with the development of vasculitis sustained by an exacerbated IgA-mediated immune response.
Case Description/Methods: In the context of the current pandemic, we report the case of a 32-year-old patient who showed clinical features of HSP that appeared in a few days after the diagnosis of Coronavirus Disease 2019 (COVID-19) mild form, confirmed by PCR test. He presented an acute onset with marked asthenia, edema and painful bilateral swelling of the knee, associated with difficulty walking. Small flat lesions distributed on the upper and lower extremity and on the posterior-chest have been identified, one day later. He needed hospitalization in a medical center where he received corticosteroid therapy, anticoagulant, antiviral with regression of skin lesions and joint swelling. After five days the skin lesions expand and after 48 hours there is intense abdominal pain accompanied by accelerated intestinal transit with blood. The objective examination reveals a rash on both lower extremity, which extends from the soles to the ankles (Fig 1). Examination of the knee joints shows no local erythema, but a painful limitation of passive movements is noted. Laboratory data indicate a biological inflammatory syndrome, proteinuria and hematuria. The immunological profile does not indicate the presence of non-COVID-19 reactive arthritis. Upper gastrointestinal examination performed at 4 days reveals gastric vascular spots.
There are no evidence of suggestive lesions for inflammatory bowel disease (IBD) observed both on colonoscopy and abdominal CT based on 7 mm parietal thickening of the descending colon and sigmoid. Clinical, laboratory, imaging and endoscopic data establish the diagnosis of HSP with nephritic syndrome and reactive arthritis in the context of Sars-CoV-2 infection. Under cortisone treatment, purpura disappears completely after 10 days.
Discussion: In our patient the presence of purpura in the absence of thrombocytopenia, as a mandatory criterion, in association with other criteria, namely arthritis reactive at onset, renal and digestive impairment, support according to EULAR / PRINTO / PRES criteria, the diagnosis of Henoch–Schönlein purpura.
Elena Toader indicated no relevant financial relationships.
Mirela Piscuc indicated no relevant financial relationships.
Andreea-Luiza Palamaru indicated no relevant financial relationships.
Elena Toader, PhD, Mirela Piscuc, MD, Andreea-Luiza Palamaru, MD. P3051 - Henoch-Schӧnlein Purpura in the Context of Sars-CoV-2 Infection – Practice Management, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.