Fatal Henoch-Schonlein purpura in an adult related to bowel perforation: report and review of the literature.

BACKGROUND: Henoch-Schonlein purpura is an idiopathic, IgA associated, systemic small-vessel vasculitis characterized by the clinical tetrad of palpable purpura, arthralgias, renal dysfunction, and abdominal pain. Whereas Henoch-Schonlein is an overwhelmingly pediatric disease, its rare diagnosis in adults carries a much higher morbidity and mortality. OBSERVATIONS: We describe a 52-year-old man with biopsy proven Henoch-Schonlein who expired from bowel perforation. CONCLUSIONS: Severe gastrointestinal complications and death from gastrointestinal involvement by Henoch-Schonlein purpura is rare. The authors surmise that multiple co-morbidities may have contributed to our patient's demise.

Multiple primary atypical vascular lesions occurring in the same breast.

Atypical vascular lesions (AVLs) of the breast are rare cutaneous vascular proliferations that appear as flesh-colored or erythematous papules or macules in women who have undergone radiation treatment for breast carcinoma. These lesions can develop in the irradiated area up to 20 years after the radiation treatment but most commonly occur within 3 to 6 years. The general consensus agrees on the benign nature of AVLs; however, their identity as benign lesions has been a source of controversy over the years, with some investigators proposing that AVLs may be a precursor lesion to postirradiation angiosarcomas. Currently, there are no specific guidelines to direct clinicians on the effective treatment of AVLs, but most AVLs are treated with total excision. This rare case describes the development of 4 AVLs within the same breast and stresses the relevance of the field effect in AVL development as well as the importance of field monitoring.