Rapid improvement of Henoch-Schonlein purpura associated with the treatment of Helicobacter pylori infection
A previously healthy 49-year-old-man was admitted to Harran University Faculty of Medicine Hospital, at Sanliurfa/Turkey in 2011, because of a one-week history of intermittent colicky abdominal pain, decreased appetite and subsequent purpura on his lower extremities. Physical examination revealed numerous erythematous macules, red-brown purpuric papules, and plaques on the legs, thighs, buttocks, and extensor surfaces of the arms []. On admission, his temperature was 36.9°C, pulse 76, respiration 14, and blood pressure 120/70 mmHg. Aside from mid-epigastric pain to palpation and had a previously known of vitiligo history that comprises the extremities, the remainder of the physical examination was unremarkable. Laboratory studies showed a white blood cell count of 23.070/mm3. The hemoglobin concentration was 13.07 g/dL, the platelet count was 393.200/mm3, elevated level of erythrocyte sedimentation rate, while normal results for serum creatinine level, serum IgA level. Urinalysis revealed microscopic hematuria and proteinuria (450 mg/24 hrs). Occult blood was found in the feces. Antinuclear antibody, rheumatoid factor, C3 was not detected and C3 levels was normal. Serologic tests for Human immunodeficiency virus and hepatitis virus (A, B, and C), were also negative. Upper endoscopy revealed findings of antrum predominant pangastritis, with erythema, and active peptic ulcus and showed patchy petechial hemorrhage of the duodenal bulb. Rapid urease test for H. pylori showed a positive result. Endoscopic biopsy specimens obtained from gastric mucosa revealed chronic active gastritis and multiple H. pylori organisms were detected within the lumina of antrum. The results of colonoscopy were negative. A biopsy specimen obtained from purpuric lesion showed a dermal perivascular and interstitial infiltrate rich in lymphocytes and neutrophils, as well as extravasations of erythrocytes and leukocytoclasis. Vessel walls showed endothelial swelling and necrosis with deposition of fibrinoid material []. The patient was treated with methylprednisolone 1 mg/kg/day for 10 days regarding to the abdominal complaints, urinalysis results, and age onset; however his complaints were not healed with this treatment. Further, the patient received a two-week treatment course consisting of lansoprazole 30 mg twice daily, amoxicillin 1000 mg twice daily, and clarithromycin 500 mg twice daily without steroid treatment. After the treatment, the abdominal manifestations dramatically subsided within three days and the purpuric skin lesions resolve within four days and by one week after starting the rash had completely resolved without further treatment. Stool test performed two months after the therapy showed a negative result, which suggested successful H. pylori eradication. The patient has had no recurrence of rash or abdominal pain, during the one year follow-up while being monitored from the outpatient clinic [].