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It is only for medical professionals to read for reference.
Many doctors have ignored it.
Let's look at a picture: the patient's total abdominal pain gradually worsened for 3 days and was admitted to the emergency department.
Gastroscope revealed diffuse edema, flaky hemorrhage and ulcers of the duodenal mucosa after the bulb, and scattered purple rashes on the abdomen, lower back, and bilateral lower limbs.
.
.
.
What disease caused it? 1.
Case summary ■ The main complaint was that the patient, a 51-year-old woman, had a 3-day emergency hospitalization with a progressive increase in total abdominal pain, accompanied by nausea, bloodless vomiting, 2-3 times with blood in the urine, low volume, blood clots, and joint pain in the extremities.
■ Past history: Past history of gastroesophageal reflux disease, denying recent use of non-steroidal anti-inflammatory drugs or aspirin and alcohol intake.
There was no abnormality in colonoscopy a month ago.
In the first two weeks, she received a week of cephalexin treatment for urinary tract infection.
■ On physical examination, diffuse abdominal tenderness without signs of peritoneum.
■ Admission laboratory and imaging examination WBC 13.
300x109/L, HB 110g/L and CRE 159.
12umol/L.
Urine test 3/red blood cell (Hp/50-60) and proteinuria (300mg/dl).
Abdominal CT showed diffuse colitis, terminal ileitis, and peripheral fat retention.
Stool culture was negative for bacteria, fungi, Clostridium difficile, and cytomegalovirus, and negative for hepatitis B and C, HIV, and antinuclear antibodies; serum C3 and C4 levels were low.
■ After diagnosis and treatment, the patient still has abdominal pain, nausea, vomiting and blood in the stool after rehydration and metronidazole anti-infection.
Subsequently, the patient underwent gastroscopy and colonoscopy.
The gastroscopy revealed diffuse edema, lamellar hemorrhage and ulcers of the duodenal mucosa behind the bulb (Figures A, B, C).
Figure AC colonoscopy showed patchy erythema throughout the colon without obvious ulcers.
Biopsy were taken and sent for pathology and special staining. On the second day after endoscopy, a small amount of macular rash found during the initial evaluation of the patient has evolved into a diffuse purple rash, extending to both lower limbs (Figure D), and there are also scattered purple rashes on the abdomen and lower back.
A biopsy of the rash was taken and sent for skin pathology evaluation.
In Figure D, the renal function deteriorated further, and the blood CRE rose to 265umo/L.
Based on clinical manifestations, skin manifestations, and endoscopic images, what do you think is the possible diagnosis for this patient? The answer slips on the blank space to get answer A.
Answer analysis: The patient’s skin biopsy revealed leukocyte debris, spilled red blood cells, and fibrin deposition in superficial and deep dermal blood vessels, consistent with leukocyte debris vasculitis.
Immunofluorescence staining was performed, and focal granular immunoglobulin A deposition was observed in the superficial dermal blood vessels.
The immunoglobulin C1q, C3, and C4 staining were negative, in line with the specific manifestations of Henoch-Schonlein purpura.
The duodenal mucosal biopsy was consistent with acute duodenitis with focal mucosal ulcers.
Combining clinical manifestations and pathology, the diagnosis is clear for Henoch-Schonlein purpura.
The case was published in Gastroenterology and Hepatology[1].
■ Follow-up treatment started with intravenous injection of 125 mg of methylprednisolone twice a day.
After 5 days of treatment, the rash, abdominal symptoms and renal function were all improved.
One week later, the patient was discharged from the hospital with oral prednisone slowly reducing the dose and taking the medicine.
Follow-up at the outpatient clinic, the renal function returned to normal within 3 weeks after discharge, and the skin purpura disappeared completely.
2.
Understanding Henoch-Schonlein Purpura (Henoch-Schonlein Purpura, HSP) is a kind of pathogen infection (streptococcal infection, virus infection), certain drugs, allergies, etc.
, which cause the formation of IgA or IgG circulating immunity in the body The complex mediates systemic vasculitis caused by the capillaries deposited in the upper dermis, now called IgA vasculitis.
Domestic reports have reported that the annual incidence of children in Taiwan is 12.
9 per 100,000.
There is no epidemiological data in the mainland.
The ratio of male to female is 1.
2-1.
8:1.
The main manifestations are purpura, abdominal pain, arthralgia and kidney damage, but platelets do not decrease [2-3 ]. Gastrointestinal involvement is caused by avascular necrosis of the epithelium due to occlusion of small capillaries [4].
Gastrointestinal symptoms are caused by submucosal hemorrhage and edema.
Purpura lesions can be seen on endoscopy, usually located in the duodenum descending.
Department, stomach and colon, and the terminal ileum can also be affected.
Total small bowel radiography showed ileum and jejunum submucosal edema, ulcers and spasms.
It is important to pay attention to skin damage, most patients have skin symptoms first.
The rash usually begins with erythema, macula, or urticaria.
The rash may be accompanied by itching but rarely with pain.
The initial rash can merge and evolve into typical petechiae, petechiae, and palpable purpura.
The rash usually appears in clusters, symmetrically distributed, mainly in gravity/pressure dependent areas, such as the lower limbs.
Hip involvement is common in young children, although pathological, it may occur in the late stages of the disease.
This is the case in the cases reported above, leading to delays in diagnosis.
According to clinical manifestations, it can be divided into simple type, abdominal type, joint type, kidney type, and mixed type.
Supportive therapy is usually recommended.
Most cases occur in children and generally have a good prognosis.
Adult cases can be complicated by serious sequelae of the disease, such as chronic kidney disease.
I hope that through the sharing of this case today, everyone will experience abdominal pain with joint and skin damage, endoscope-diffuse gastrointestinal mucosal hemorrhage and edema, ulcerative lesions, excretory ulcerative colitis, intestinal tuberculosis, Behçet’s Diseases and other diseases, adult cases should also consider the possibility of Henoch-Schonlein purpura.
References: [1] Jason Welch, Krishna Kasturi, and Andrea Duchini, An Unusual Case of Ulcerative Duodenitis, doi: 10.
1053/j.
gastro.
2010.
05.
090 [2] Reamy BV, Williams PM, Lindsay TJ.
Henoch-Schonlein purpura .
Am Fam Physician 2009;80:697–704.
[3]Kunicka A,Pruszczyk P,Kryst A.
Henoch-Schonlein purpura:an atypical cause of abdominal pain in a 70-year-old man:case report.
Pol Arch Med Wewn 2009;119:509–513.
[4]Ebert EC.
Gastrointestinal manifestations of Henoch-Schonlein Purpura.
Dig Dis Sci 2008;53:2011–2019.
Many doctors have ignored it.
Let's look at a picture: the patient's total abdominal pain gradually worsened for 3 days and was admitted to the emergency department.
Gastroscope revealed diffuse edema, flaky hemorrhage and ulcers of the duodenal mucosa after the bulb, and scattered purple rashes on the abdomen, lower back, and bilateral lower limbs.
.
.
.
What disease caused it? 1.
Case summary ■ The main complaint was that the patient, a 51-year-old woman, had a 3-day emergency hospitalization with a progressive increase in total abdominal pain, accompanied by nausea, bloodless vomiting, 2-3 times with blood in the urine, low volume, blood clots, and joint pain in the extremities.
■ Past history: Past history of gastroesophageal reflux disease, denying recent use of non-steroidal anti-inflammatory drugs or aspirin and alcohol intake.
There was no abnormality in colonoscopy a month ago.
In the first two weeks, she received a week of cephalexin treatment for urinary tract infection.
■ On physical examination, diffuse abdominal tenderness without signs of peritoneum.
■ Admission laboratory and imaging examination WBC 13.
300x109/L, HB 110g/L and CRE 159.
12umol/L.
Urine test 3/red blood cell (Hp/50-60) and proteinuria (300mg/dl).
Abdominal CT showed diffuse colitis, terminal ileitis, and peripheral fat retention.
Stool culture was negative for bacteria, fungi, Clostridium difficile, and cytomegalovirus, and negative for hepatitis B and C, HIV, and antinuclear antibodies; serum C3 and C4 levels were low.
■ After diagnosis and treatment, the patient still has abdominal pain, nausea, vomiting and blood in the stool after rehydration and metronidazole anti-infection.
Subsequently, the patient underwent gastroscopy and colonoscopy.
The gastroscopy revealed diffuse edema, lamellar hemorrhage and ulcers of the duodenal mucosa behind the bulb (Figures A, B, C).
Figure AC colonoscopy showed patchy erythema throughout the colon without obvious ulcers.
Biopsy were taken and sent for pathology and special staining. On the second day after endoscopy, a small amount of macular rash found during the initial evaluation of the patient has evolved into a diffuse purple rash, extending to both lower limbs (Figure D), and there are also scattered purple rashes on the abdomen and lower back.
A biopsy of the rash was taken and sent for skin pathology evaluation.
In Figure D, the renal function deteriorated further, and the blood CRE rose to 265umo/L.
Based on clinical manifestations, skin manifestations, and endoscopic images, what do you think is the possible diagnosis for this patient? The answer slips on the blank space to get answer A.
Answer analysis: The patient’s skin biopsy revealed leukocyte debris, spilled red blood cells, and fibrin deposition in superficial and deep dermal blood vessels, consistent with leukocyte debris vasculitis.
Immunofluorescence staining was performed, and focal granular immunoglobulin A deposition was observed in the superficial dermal blood vessels.
The immunoglobulin C1q, C3, and C4 staining were negative, in line with the specific manifestations of Henoch-Schonlein purpura.
The duodenal mucosal biopsy was consistent with acute duodenitis with focal mucosal ulcers.
Combining clinical manifestations and pathology, the diagnosis is clear for Henoch-Schonlein purpura.
The case was published in Gastroenterology and Hepatology[1].
■ Follow-up treatment started with intravenous injection of 125 mg of methylprednisolone twice a day.
After 5 days of treatment, the rash, abdominal symptoms and renal function were all improved.
One week later, the patient was discharged from the hospital with oral prednisone slowly reducing the dose and taking the medicine.
Follow-up at the outpatient clinic, the renal function returned to normal within 3 weeks after discharge, and the skin purpura disappeared completely.
2.
Understanding Henoch-Schonlein Purpura (Henoch-Schonlein Purpura, HSP) is a kind of pathogen infection (streptococcal infection, virus infection), certain drugs, allergies, etc.
, which cause the formation of IgA or IgG circulating immunity in the body The complex mediates systemic vasculitis caused by the capillaries deposited in the upper dermis, now called IgA vasculitis.
Domestic reports have reported that the annual incidence of children in Taiwan is 12.
9 per 100,000.
There is no epidemiological data in the mainland.
The ratio of male to female is 1.
2-1.
8:1.
The main manifestations are purpura, abdominal pain, arthralgia and kidney damage, but platelets do not decrease [2-3 ]. Gastrointestinal involvement is caused by avascular necrosis of the epithelium due to occlusion of small capillaries [4].
Gastrointestinal symptoms are caused by submucosal hemorrhage and edema.
Purpura lesions can be seen on endoscopy, usually located in the duodenum descending.
Department, stomach and colon, and the terminal ileum can also be affected.
Total small bowel radiography showed ileum and jejunum submucosal edema, ulcers and spasms.
It is important to pay attention to skin damage, most patients have skin symptoms first.
The rash usually begins with erythema, macula, or urticaria.
The rash may be accompanied by itching but rarely with pain.
The initial rash can merge and evolve into typical petechiae, petechiae, and palpable purpura.
The rash usually appears in clusters, symmetrically distributed, mainly in gravity/pressure dependent areas, such as the lower limbs.
Hip involvement is common in young children, although pathological, it may occur in the late stages of the disease.
This is the case in the cases reported above, leading to delays in diagnosis.
According to clinical manifestations, it can be divided into simple type, abdominal type, joint type, kidney type, and mixed type.
Supportive therapy is usually recommended.
Most cases occur in children and generally have a good prognosis.
Adult cases can be complicated by serious sequelae of the disease, such as chronic kidney disease.
I hope that through the sharing of this case today, everyone will experience abdominal pain with joint and skin damage, endoscope-diffuse gastrointestinal mucosal hemorrhage and edema, ulcerative lesions, excretory ulcerative colitis, intestinal tuberculosis, Behçet’s Diseases and other diseases, adult cases should also consider the possibility of Henoch-Schonlein purpura.
References: [1] Jason Welch, Krishna Kasturi, and Andrea Duchini, An Unusual Case of Ulcerative Duodenitis, doi: 10.
1053/j.
gastro.
2010.
05.
090 [2] Reamy BV, Williams PM, Lindsay TJ.
Henoch-Schonlein purpura .
Am Fam Physician 2009;80:697–704.
[3]Kunicka A,Pruszczyk P,Kryst A.
Henoch-Schonlein purpura:an atypical cause of abdominal pain in a 70-year-old man:case report.
Pol Arch Med Wewn 2009;119:509–513.
[4]Ebert EC.
Gastrointestinal manifestations of Henoch-Schonlein Purpura.
Dig Dis Sci 2008;53:2011–2019.
