Spontaneous Bacterial Peritonitis and Henoch-Schönlein Purpura in a Patient with Liver Cirrhosis
Open Access
- 7 May 2015
- journal article
- case report
- Published by Hindawi Limited in Case Reports in Medicine
- Vol. 2015, 1-5
- https://doi.org/10.1155/2015/340894
Abstract
Henoch-Schönlein purpura (HSP) is a small vessel systemic vasculitis, predominantly affecting children, characterized by a tetrad of manifestations, specifically palpable purpura, arthralgia, abdominal pain, and renal disease. HSP in the adult population is rare, and no case has been described of HSP in liver cirrhosis with spontaneous bacterial peritonitis (SBP). We present the case of a 58-year-old male with liver cirrhosis, who was subsequently diagnosed with SBP and later HSP. In this patient, the diagnosis of HSP was demonstrated clinically by his palpable purpura, diarrhea, hematuria, and abdominal pain and confirmed pathologically by his renal and skin biopsies demonstrating leukocytoclastic vasculitis and IgA complexes. We believe that this is an example of altered IgA processing in cirrhosis leading to the development of IgA immune complexes and ultimately HSP. The patient additionally had SBP, which may have increased his risk for developing HSP given antigen processing by mucosa-associated lymphoid tissues leading to immune complex deposition, which may not have been effectively cleared in the context of his liver disease. The patient unfortunately died of gastrointestinal hemorrhage, which is unclear to be due to his underlying cirrhosis or a gastrointestinal manifestation of HSP itself.Keywords
This publication has 11 references indexed in Scilit:
- Epidemiology of immunoglobulin A vasculitis (Henoch–Schönlein)Current Opinion in Rheumatology, 2013
- Comparative clinical and epidemiological study of hypersensitivity vasculitis versus Henoch-Schönlein purpura in adultsSeminars in Arthritis and Rheumatism, 1999
- Henoch‐Schönlein purpura in adulthood and childhood. Two different expressions of the same syndromeArthritis & Rheumatism, 1997
- Rapidly Progressive Glomerulonephritis in Association with Henoch-Schönlein Purpura in a Patient with Advanced Liver CirrhosisNephron, 1995
- Henoch-Schönlein Vasculitis as a Manifestation of IgA-Associated Disease in CirrhosisAmerican Journal of Kidney Diseases, 1992
- Fatal adult Henoch‐SchÖnlein purpura due to small intestinal infarctionJournal of Internal Medicine, 1992
- [Benign monoclonal gammopathy in a female patient with Schönlein-Henoch glomerulonephritis and liver cirrhosis].1990
- Long-term outcome of Schönlein-Henoch nephritis in the adult.1989
- Circulating IgA immune complexes and skin IgA deposits in liver disease relation to liver histopathologyDigestive Diseases and Sciences, 1988
- Cirrhotic Glomerulonephritis: Incidence, Morphology, Clinical Features, and PathogenesisAmerican Journal of Kidney Diseases, 1987