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2.
J Biol Regul Homeost Agents ; 33(5 Suppl. 1): 69-74, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31630717

RESUMO

Henoch Schonlein Purpura (HSP) is a systematic IgA-mediated vasculitic disease that affects the small vessels of the skin, the joints, the gastrointestinal tract and the kidneys (1). It is the most common childhood vaculitis, with an incidence estimated at 3-26 per 100,000 children, and with a male-to-female ratio of 2:1 (2-6). The 90% of patients are under 10 years of age, with a mean age of 4 years (4). It seems to be most common in fall and winter in children, and summer and winter in adults (7). Recent studies suggested a strong genetic predisposition in individuals with immunoglobulin Avasculitis (IgAV) associated to HLA class II region. Clinically, the non-thrombocytopenic purpura often located on lower extremities and buttocks is the essential element for the diagnosis of HSP. Treatment is supportive, because the disease is usually benign and self-limited. Indeed, in children, the prognosis is good, with a self-limited course and without any complications and after a median follow-up of 12 months, complete recovery was obtained in 83% of the IgAV patients (4, 8). The aim of our study is to describe some atypical presentations of the HSP in children.


Assuntos
Púrpura de Schoenlein-Henoch/diagnóstico , Criança , Pré-Escolar , Feminino , Predisposição Genética para Doença , Humanos , Masculino , Prognóstico
4.
Kidney Blood Press Res ; 44(4): 754-764, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31387105

RESUMO

BACKGROUND: Henoch-Schönlein purpura nephritis (HSPN) is a common vasculitis involving the kidneys, with a lower incidence in adults. Meanwhile, nephrotic syndrome (NS) can appear in HSPN. However, the clinicopathological features and renal outcome of adult-onset HSPN presenting with NS (NS-HSPN) have not been well clarified. METHODS: A total of 191 HSPN patients were prospectively analyzed and comparisons were made between NS-HSPN and non-NS-HSPN. Multivariate Cox regression analysis was carried out to find the unfavorable factors of renal outcome of NS-HSPN. RESULTS: Among the 191 patients, 44 (23.0%) had NS-HSPN. Apart from edema and abdominal pain, patients with NS-HSPN tended to have lower levels of erythrocytes and hemoglobulin in blood as well as a greater number of erythrocytes in urine (p < 0.05). Mesangial proliferation was the most common pathological lesion in HSPN and the rates of crescent formation were significantly different, with 54.5% in NS-HSPN and 33.3% in non-NS-HSPN (p < 0.05). Notably, 18.2 and 4.8% of patients reached the composite endpoints in the NS-HSPN and non-NS-HSPN groups, respectively (p < 0.05), demonstrating that NS-HSPN patients were more likely to progress to end-stage renal disease and had a worse outcome. We also found that hypertension, estimated glomerular filtration rate (eGFR), cystatin, and tubular atrophy/interstitial fibrosis (HR > 1, p < 0.05) at onset were correlated with adverse outcome in NS-HSPN. CONCLUSION: NS-HSPN had more severe clinicopathological manifestations and poorer prognosis. The adverse predictors of NS-HSPN principally depend on clinicopathological presentation rather than on different therapies, and hypertension, eGFR, cystatin, and tubular atrophy/interstitial fibrosis can serve as independent risk factors in NS-HSPN.


Assuntos
Síndrome Nefrótica/complicações , Púrpura de Schoenlein-Henoch/complicações , Adolescente , Adulto , Idade de Início , Idoso , Atrofia , Estudos de Casos e Controles , Cistatinas , Fibrose , Taxa de Filtração Glomerular , Humanos , Hipertensão , Masculino , Pessoa de Meia-Idade , Síndrome Nefrótica/diagnóstico , Síndrome Nefrótica/patologia , Prognóstico , Estudos Prospectivos , Púrpura de Schoenlein-Henoch/diagnóstico , Púrpura de Schoenlein-Henoch/patologia , Fatores de Risco , Adulto Jovem
6.
Trials ; 20(1): 538, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31464626

RESUMO

BACKGROUND: Henoch-Schönlein purpura nephritis (HSPN) is the most common secondary glomerular disease in children. Currently, the treatment for HSPN is always selected based on the Kidney Disease Improving Global Outcomes guidelines; however, this approach may lead to undertreatment, especially in patients with persistent proteinuria that does not reach nephrotic levels and/or hematuria and those with a pathological classification between grades 1 and 3 according to the International Study of Kidney Disease in Children. This study was performed to evaluate the curative effect and safety of a traditional Chinese medicine (TCM) integrated treatment program in this type of HSPN. METHODS: This multicenter, open-label, large-sample, randomized controlled trial was performed in China and included 500 children with HSPN exhibiting mild pathological patterns. The treatment group to control group ratio was 2:1, and each group was further stratified into two types, light and heavy, according to urinary protein quantification and pathological type. The treatment group received tripterygium glycosides (TGs), tanshinone IIa sodium sulfonate injection, and Chinese herbs selected based on syndrome differentiation in TCM. The heavy and light subgroups received treatment courses and dosages of TG. In the control groups, the light group received benazepril hydrochloride tablets, low molecular weight heparin calcium injection, dipyridamole tablets, and a Chinese medicine placebo, while the heavy group received the same treatment plus prednisone. All groups were treated for 3 months and then followed up for 9 months. The efficacy and safety of the treatments were then evaluated among the groups. DISCUSSION: Currently, few treatments are available for HSPN patients with mild pathological patterns indicating light to moderate proteinuria and/or hematuresis. In this large-sample study, we provide a new approach for HSPN that includes an integrated treatment program that incorporates TCM. TRIAL REGISTRATION: Clinical Trials.gov, NCT03591471 . Re-registered on 19 July 2018.


Assuntos
/uso terapêutico , Medicamentos de Ervas Chinesas/uso terapêutico , Glicosídeos/uso terapêutico , Nefrite/tratamento farmacológico , Púrpura de Schoenlein-Henoch/tratamento farmacológico , Tripterygium , /efeitos adversos , Adolescente , Fatores Etários , Criança , Pré-Escolar , China , Quimioterapia Combinada , Medicamentos de Ervas Chinesas/efeitos adversos , Feminino , Glicosídeos/efeitos adversos , Glicosídeos/isolamento & purificação , Humanos , Masculino , Estudos Multicêntricos como Assunto , Nefrite/diagnóstico , Púrpura de Schoenlein-Henoch/diagnóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento , Tripterygium/química
7.
BMJ Case Rep ; 12(7)2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31320374

RESUMO

A 30-year-old Caucasian woman with no prior medical history presented with pedal oedema, arthralgias and abdominal pain with diarrhoea, following a respiratory infection. She had mild abdominal tenderness along with a purpuric rash on the extremities and was anaemic. Following initial workup for anaemia and rash, her condition deteriorated with renal impairment, respiratory failure and seizures necessitating ventilatory support, dialysis and steroids. Serologies were negative, and skin biopsy showed leucocytoclastic vasculitis without vascular IgA deposition, and renal biopsy showed subendothelial, mesangial deposits of IgA with C3 indicative of Henoch-Schonlein purpura (HSP). She was treated with steroids, haemodialysis and on 6-month follow-up recovered renal function. We present the case to illustrate that HSP, though rare in adults, can present with multiorgan failure, with renal, pulmonary and central nervous system involvement, and the need for early diagnosis and prompt treatment for rapid clinical recovery.


Assuntos
Lesão Renal Aguda/etiologia , Glomerulonefrite/etiologia , Púrpura de Schoenlein-Henoch/complicações , Síndrome do Desconforto Respiratório do Adulto/etiologia , Convulsões/etiologia , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/patologia , Lesão Renal Aguda/terapia , Corticosteroides/uso terapêutico , Adulto , Anticonvulsivantes/uso terapêutico , Biópsia , Eletroencefalografia , Feminino , Glomerulonefrite/patologia , Glomerulonefrite/terapia , Humanos , Imagem por Ressonância Magnética , Púrpura de Schoenlein-Henoch/diagnóstico , Púrpura de Schoenlein-Henoch/patologia , Púrpura de Schoenlein-Henoch/terapia , Diálise Renal , Respiração Artificial , Síndrome do Desconforto Respiratório do Adulto/terapia , Convulsões/diagnóstico , Convulsões/tratamento farmacológico
8.
Eur J Pediatr ; 178(8): 1275-1281, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31230197

RESUMO

Immunoglobulin A (IgA) vasculitis (Henoch-Schonlein purpura (HSP)) is the most common vasculitis in children. It is characterized by purpuric rash, arthritis, gastrointestinal, and/or renal involvement. Spontaneous resolution is the typical outcome. In chronic cutaneous manifestations of IgA vasculitis, dapsone seems to show a good effectiveness. Multiple case reports and case series about dapsone in chronic IgA vasculitis are available. However, no clear evaluation of its indications, its effectiveness, or its usage guidelines (optimal dosage or duration of treatment) is available. We reviewed the published cases of IgA vasculitis treated by dapsone and compared them with 2 similar cases that we encountered. Seventeen patients (ranging from 22 months old to 16 years old) with severe or persistent clinical signs of IgA vasculitis were included. Dapsone showed good results on the resolution of cutaneous lesions but not on renal manifestations. Complications (methemoglobinemia) were observed on 1 patient. Half of the patients relapsed after treatment discontinuation. The difference between the time lapse before initiation and the duration of the treatment was not significant.Conclusion: We suggest that dapsone can have a positive effect in chronic IgA vasculitis when cutaneous manifestations last more than 6 weeks at the dosage of 1-2 mg/kg once per day during 1 week. What is Known: • IgA vasculitis or Henoch-Schonlein purpura is the most common vasculitis in children and affects mostly small vessels of the skin, kidney, and gastrointestinal tract. It resolves spontaneously in most of the cases. Exceptionally, cutaneous lesions can last several weeks. • Dapsone is a bacteriostatic antibacterial sulfonamide drug found to be effective in the treatment of some inflammatory dermatological diseases like IgA vasculitis. What is New: • Dapsone is effective against chronic purpuric lesion (> 6 weeks) at the minimal dose of 1 mg/kg/day. • Relapse occurs frequently after discontinuation but responds after a second course of treatment. A longer duration of treatment or a delay in treatment by dapsone does not seem to influence the relapse rate.


Assuntos
Dapsona/uso terapêutico , Antagonistas do Ácido Fólico/uso terapêutico , Púrpura de Schoenlein-Henoch/tratamento farmacológico , Pré-Escolar , Doença Crônica , Feminino , Humanos , Masculino , Púrpura de Schoenlein-Henoch/diagnóstico
9.
J Clin Neurosci ; 67: 270-271, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31201050

RESUMO

Immunoglobulin A vasculitis (IgAV) occasionally induces central nervous system (CNS) involvement, which is usually transient with no sequelae except for hemorrhagic stroke. It is thought to be useful to measure serum and cerebrospinal fluid (CSF) cytokine levels for better understanding the pathological condition in encephalopathy, but there have been no reports in acute encephalopathy with IgAV. We describe an 8-year-old boy with IgAV who had neurological sequelae after complication of acute encephalopathy, focusing on the cytokine profiles and unique biphasic findings of magnetic resonance imaging. He presented with status epilepticus and mildly intensified area in the occipital lobe on the fluid-attenuated inversion recovery view. Arterial spin labeling (ASL) revealed the reduction of cerebral blood flow in the left hemisphere. On day 5 of illness, these abnormal findings disappeared, but delayed hyperintensity lesions on diffusion-weighted images newly emerged. Furthermore, CSF interleukin (IL)-6 levels markedly increased without elevated levels of IL-10 during the acute phase of disease. He suffered from long-lasting hemiparesis and intellectual impairment. In conclusion, acute encephalopathy with IgAV could cause neurological sequelae by prolonged seizure, and elevated IL-6 in CSF and laterality of cerebral blood flow in ASL might be useful to predict the prognosis of CNS dysfunction of IgAV.


Assuntos
Encefalopatias/diagnóstico , Púrpura de Schoenlein-Henoch/diagnóstico , Convulsões/diagnóstico , Encefalopatias/etiologia , Criança , Humanos , Imunoglobulina A/imunologia , Masculino , Púrpura de Schoenlein-Henoch/complicações , Convulsões/etiologia
10.
Int J Dermatol ; 58(9): 1092-1097, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31250447

RESUMO

BACKGROUND: Henoch-Schonlein purpura (HSP) is a systemic small vessel vasculitis that is mainly caused by IgA1-type immune complex deposition. Advanced oxidation protein products (AOPPs) are specific markers of protein oxidation. OBJECTIVE: To explore the role of AOPPs in the pathogenesis of HSP. METHODS: There are 51 HSP patients who were divided into four subgroups: (i) skin type - 20 cases; (ii) joint type - 8 cases; (iii) abdominal type - 12 cases; (iv) renal type - 11 cases; and 18 healthy volunteers were enrolled as controls. The serum levels of AOPPs and Gd-IgA1 were quantified by an HAA-lectin-based ELISA. The Cosmc mRNA expression in peripheral B lymphocytes was measured by RT-PCR. RESULTS: 1. Advanced oxidation protein products in different subgroups of HSP patients are all higher than the controls, while the renal-type subgroup is the highest and the skin-type subgroup is the lowest. 2. Spearman correlation analysis shows that: (i) AOPPs and Gd-IgA1 in HSP patients are positively correlated; both of them are positively correlated with the disease severity scores; (ii) AOPPs are negatively correlated with the relative expression value (RQ) of Cosmc mRNA. CONCLUSION: Advanced oxidation protein products play an important role in the pathogenesis of HSP, especially in renal-type patients.


Assuntos
Produtos da Oxidação Avançada de Proteínas/sangue , Imunoglobulina A/metabolismo , Chaperonas Moleculares/genética , Púrpura de Schoenlein-Henoch/sangue , Adolescente , Adulto , Linfócitos B/metabolismo , Biomarcadores/sangue , Biomarcadores/metabolismo , Criança , Feminino , Glicosilação , Humanos , Imunoglobulina A/sangue , Imunoglobulina A/imunologia , Masculino , Púrpura de Schoenlein-Henoch/diagnóstico , Púrpura de Schoenlein-Henoch/imunologia , RNA Mensageiro/metabolismo , Índice de Gravidade de Doença , Adulto Jovem
11.
Intern Med ; 58(17): 2551-2554, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31178497

RESUMO

Renal disease is a common complication of rheumatoid arthritis (RA) and can occur secondary to RA or be induced by therapeutic agents. Recently, glomerular deposition of galactose-deficient IgA1 (Gd-IgA1) was identified as a feature of primary IgA vasculitis with nephritis (IgA-VN). We herein report a case of IgA-VN in an RA patient whose disease activity was controlled by treatment with etanercept. To distinguish between primary IgA-VN and secondary IgA-VN caused by RA or etanercept, we performed immunostaining of renal biopsy sections with the Gd-IgA1-specific antibody KM55. Positive KM55 staining confirmed the diagnosis of primary IgA-VN in a patient with RA.


Assuntos
Artrite Reumatoide/complicações , Glomerulonefrite por IGA/diagnóstico , Imunoglobulina A/análise , Púrpura de Schoenlein-Henoch/diagnóstico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Etanercepte/uso terapêutico , Feminino , Galactose/imunologia , Glomerulonefrite por IGA/etiologia , Glomerulonefrite por IGA/imunologia , Humanos , Pessoa de Meia-Idade , Púrpura de Schoenlein-Henoch/etiologia , Púrpura de Schoenlein-Henoch/imunologia
12.
J Int Med Res ; 47(6): 2545-2554, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31068035

RESUMO

OBJECTIVE: To investigate the relationship between anti-α-1,4-D-polygalacturonic acid (PGA) antibodies, particularly immunoglobulin (Ig)A, and Henoch-Schönlein purpura (HSP) in children. METHODS: This observational case-control study investigated PGA-IgA, PGA-IgG, and PGA/PGA-IgA circulating immune complex (PGA/PGA-IgA CIC) in paediatric patients with HSP versus controls. Children with HSP were also evaluated for food specific IgG and food intolerance. Between-group differences in anti-PGA antibodies were analysed. RESULTS: Serum PGA-IgA and PGA-IgG levels were significantly increased in patients with acute HSP ( n = 251) versus those with urticaria ( n = 48), acute respiratory infections ( n = 95), surgical controls ( n = 53) and neonates ( n = 92). PGA/PGA-IgA CIC levels were also significantly higher in the acute HSP group versus surgical control and neonate groups. Levels of PGA/PGA-IgA CIC and PGA-IgA were significantly correlated ( r = 0.997), and PGA-IgA showed high diagnostic specificity for HSP. No statistically significant differences were observed in PGA-IgA and PGA-IgG between various degrees of food intolerance in children with HSP. CONCLUSION: Increased anti-PGA antibodies, particularly PGA-IgA and PGA/PGA-IgA CIC, were significantly associated with acute HSP in children. Food intolerance was not found to be associated with increased anti-PGA antibodies in children with HSP.


Assuntos
Autoanticorpos/sangue , Imunoglobulina A/imunologia , Imunoglobulina G/imunologia , Pectinas/imunologia , Púrpura de Schoenlein-Henoch/diagnóstico , Adolescente , Autoanticorpos/imunologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Prognóstico , Púrpura de Schoenlein-Henoch/sangue , Púrpura de Schoenlein-Henoch/imunologia
13.
BMJ Case Rep ; 12(5)2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-31129640

RESUMO

Axial spondyloarthropathies are characterised by bilateral sacroiliitis, asymmetric oligoarthritis, association with the human leucocyte antigen (HLA)-B27, enthesitis and dactylitis. Although IgA nephropathy has a well-documented association with seronegative spondyloarthropathies, the association with Henoch-Schonlein purpura (HSP) has been documented only in few case reports. The present case is that of a 26-year-old man who presented with fever, lower limb arthritis, abdominal pain, palpable purpura over the buttocks and lower limbs, and clinical features of sacroiliitis. His blood tests showed elevated inflammatory markers and rheumatoid factor was negative. CT scan of the sacroiliac joints confirmed sacroiliitis. Skin biopsy revealed neutrophilic small vessel vasculitis. HLA-B27 was positive in blood. A diagnosis of HSP with HLA-B27 positive axial spondyloarthritis was made. HSP can be associated with HLA-B27 positive axial spondyloarthritis and has to be considered while evaluating for causes of cutaneous small vessel vasculitis in such patients.


Assuntos
Púrpura de Schoenlein-Henoch/diagnóstico , Espondilartrite/diagnóstico , Dor Abdominal/tratamento farmacológico , Dor Abdominal/etiologia , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Antirreumáticos/uso terapêutico , Antígeno HLA-B27/sangue , Humanos , Masculino , Metotrexato/uso terapêutico , Púrpura de Schoenlein-Henoch/complicações , Sacroileíte/diagnóstico por imagem , Sacroileíte/tratamento farmacológico , Sacroileíte/etiologia , Espondilartrite/sangue , Espondilartrite/complicações , Espondilartrite/tratamento farmacológico , Sulfassalazina/uso terapêutico , Tomografia Computadorizada por Raios X
14.
Diagn Pathol ; 14(1): 40, 2019 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-31077245

RESUMO

BACKGROUND: Henoch-Schönlein purpura nephritis (HSPN) shares many similarities with IgA nephropathy. We aimed to analyze the predictive value of the International Study of Kidney Disease in Children (ISKDC) classification and the updated Oxford classification for IgA nephropathy in HSPN patients. METHODS: Data of 275 HSPN patients (aged≥14 years) were retrieved, and all of them underwent a renal biopsy. We re-classified the biopsies according to the ISKDC classification and the updated Oxford classification to analyze their correlations with clinical features and renal outcomes. The renal endpoints were defined as ≥30% reduction in baseline estimated glomerular filtration rate (eGFR) in 2 years, doubling of serum creatinine (Scr) or end stage renal disease. RESULTS: During follow-up period of 56(30,86) months, 30(10.9%) patients reached renal endpoints. Segmental sclerosis was the only pathological feature independently associated with renal endpoints (HR 4.086, 95%CI 1.111-15.026, P = 0.034). Tubular atrophy/ interstitial fibrosis was associated with eGFR and Scr levels, and its correlation with renal endpoints was found by univariate analysis. Endocapillary hypercellularity was associated with 24 h urine protein and is of prognostic value in univariate analysis. Mesangial hypercellularity was not associated with clinical features or renal endpoints. Crescents were associated with 24 h urine protein, Scr and eGFR levels, but both ISKDC and updated Oxford classifications of crescents were not associated with renal endpoints by multivariate analysis. CONCLUSIONS: The updated Oxford classification can help in disease management and renal outcome prediction of HSPN.


Assuntos
Glomerulonefrite por IGA/patologia , Nefrite/classificação , Púrpura de Schoenlein-Henoch/classificação , Adolescente , Adulto , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Rim/patologia , Glomérulos Renais/patologia , Glomérulos Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrite/diagnóstico , Nefrite/patologia , Prognóstico , Púrpura de Schoenlein-Henoch/diagnóstico , Púrpura de Schoenlein-Henoch/patologia , Púrpura de Schoenlein-Henoch/cirurgia , Adulto Jovem
16.
Int J Rheum Dis ; 22(7): 1271-1277, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30896086

RESUMO

OBJECTIVES: To describe the natural history and risk factors of renal involvement in our Henoch-Schönlein purpura (HSP) inception cohort. METHODS: HSP patients followed at our center for at least 6 months between 1/2009-4/2017 were included. A 2-year urinalysis (UA) monitoring protocol was adopted (6 monthly and another 6 of 3 monthly UA). Renal involvement included minimal renal involvement defined as isolated hematuria (urine red blood cells >5/high-power field or 10/µL) and/or proteinuria (urine protein >1+), and renal impairment defined as nephritic, nephrotic symptoms, or renal insufficiency. Recurrent HSP were excluded. Kaplan-Meier estimates and log-rank test were used to analyze the duration to onset and resolution of abnormal UA. Relationships between demographic and clinical features and renal involvement were studied using logistic regression analyses. RESULTS: Two hundred and thirty-eight patients (52.9% male) were analyzed. Median duration of follow up was 20.6 (interquartile range 11.3-24.4) months. Eighty-nine children (37.4%) developed abnormal UA either at diagnosis (n = 43), or during follow up (n = 46), mostly (91.0%) within 6 months. Seventeen patients (7.1%) developed renal impairment. Among patients without renal impairment, an earlier subsidence (P = 0.008) was noted in those with normal UA at diagnosis and most abnormal UA resolved by 18 months in this subgroup. Older age at diagnosis was a risk factor of renal involvement (P < 0.001). Prednisolone therapy for non-renal indications did not affect the onset or duration of renal involvement. CONCLUSIONS: Normal UA at diagnosis indicated a shorter duration of renal involvement. We propose a curtailed duration of follow up for those with normal and abnormal UA at diagnosis.


Assuntos
Biomarcadores/urina , Nefropatias/diagnóstico , Púrpura de Schoenlein-Henoch/diagnóstico , Fatores Etários , Criança , Pré-Escolar , Progressão da Doença , Feminino , Glucocorticoides/uso terapêutico , Humanos , Nefropatias/etiologia , Nefropatias/urina , Masculino , Valor Preditivo dos Testes , Prednisolona/uso terapêutico , Púrpura de Schoenlein-Henoch/complicações , Púrpura de Schoenlein-Henoch/tratamento farmacológico , Púrpura de Schoenlein-Henoch/urina , Sistema de Registros , Medição de Risco , Fatores de Risco , Fatores de Tempo , Urinálise
17.
Pediatrics ; 143(4)2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30846618

RESUMO

Exercise-induced purpura, which has also been called "golfer's purpura," is a phenomenon that has been rarely reported in the pediatric literature. This is the first case series in which this benign vasculopathy, which is most often associated with warm weather and high-impact activity, is described. In this series, we describe 5 patients, most of whom had an erythematous purpuric rash above the sock line that extended to the knees and was associated with warm weather and prolonged activity. Exercise-induced purpura may be mistaken for Henoch-Schönlein purpura or as a manifestation of a possible systemic vasculitis. Recognition of this benign condition is vital to avoid an unnecessary workup and a costly evaluation with accompanying anxiety.


Assuntos
Exercício , Púrpura/etiologia , Púrpura/patologia , Adolescente , Biópsia por Agulha , Criança , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Masculino , Púrpura de Schoenlein-Henoch/diagnóstico , Remissão Espontânea , Amostragem
18.
Nurs Womens Health ; 23(1): 38-48, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30738557

RESUMO

Anaphylactoid syndrome of pregnancy (ASP) is a widespread, proinflammatory, anaphylactic-like reaction that can occur when amniotic fluid enters the maternal blood circulation. ASP is characterized by four cardinal findings: respiratory distress, altered mental status, hypotension, and disseminated intravascular coagulation. ASP is commonly associated with maternal and neonatal mortality. Early recognition followed by prompt and aggressive treatment can improve survival rates and are among the most critical activities for nurses and other clinicians caring for women with ASP.


Assuntos
Púrpura de Schoenlein-Henoch/diagnóstico , Adulto , Antipruriginosos/uso terapêutico , Atropina/uso terapêutico , Inibidores de Ciclo-Oxigenase/uso terapêutico , Feminino , Humanos , Hipotensão/complicações , Hipotensão/etiologia , Cetorolaco/uso terapêutico , Ondansetron/uso terapêutico , Parassimpatolíticos/uso terapêutico , Gravidez , Púrpura de Schoenlein-Henoch/mortalidade , Púrpura de Schoenlein-Henoch/fisiopatologia , Fatores de Risco
19.
Rinsho Ketsueki ; 60(1): 51-56, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-30726825

RESUMO

A 37-year-old male with chief complaints of vomiting, abdominal pain, and diarrhea presented to our hospital in June 2017. A blood test detected increased inflammatory response, and a computed tomography scan showed that wall thickening extended from the terminal ileum to the entire large intestine. Bacterial enteritis was suspected because his household members developed infectious enteritis; however, his symptoms did not improve after antibiotic treatment. High fever and peritoneal signs were observed on the 10th day of admission, and palpable purpura appeared on the lower extremities. The patient was administered methylprednisolone because Henoch-Schönlein purpura was also suspected. Subsequently, his symptoms improved, and the purpura disappeared.


Assuntos
Enterite , Metilprednisolona/uso terapêutico , Púrpura de Schoenlein-Henoch/diagnóstico , Dor Abdominal , Adulto , Diagnóstico Diferencial , Humanos , Íleo/patologia , Masculino , Púrpura de Schoenlein-Henoch/tratamento farmacológico
20.
Paediatr Int Child Health ; 39(3): 219-223, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-29621936

RESUMO

About 50-75% of patients with Henoch-Schönlein purpura (HSP) develop gastro-intestinal symptoms with surgical complications such as intussusception occurring in 0.7-13.6%. In 10-40% of patients, however, gastro-intestinal manifestations may precede the onset of purpura. In patients with gastro-intestinal tract involvement without purpura, confirming the diagnosis of HSP and determining the appropriate treatment remains difficult. A seven-year-old boy presented with recurrent intussusception owing to HSP without purpura. It was confirmed pathologically and treated via colonoscopy. Early colonoscopic intervention can contribute to the early diagnosis of HSP and its subsequent management by avoiding unnecessary surgical invasion.


Assuntos
Colonoscopia/métodos , Intussuscepção/diagnóstico , Intussuscepção/prevenção & controle , Púrpura de Schoenlein-Henoch/complicações , Púrpura de Schoenlein-Henoch/diagnóstico , Criança , Humanos , Masculino , Prevenção Secundária
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