Ebru AYPAR, Duygu DEMİRTAŞ, Hayrettin Hakan AYKAN, Fehime KARA EROĞLU, Ali DÜZOVA

A girl with Henoch Schönlein purpura associated with acute rheumatic fever and review of literature

Henoch Schönlein purpura (HSP) with acute rheumatic fever (ARF) is arare entity and only few cases have been reported so far. In all previouslyreported cases with HSP and ARF, patients initially presented with purpuricrash, arthralgia/arthritis, or abdominal pain and later diagnosed as ARF. Wereport an 11-year-old girl with features of both ARF and HSP. She initiallypresented with arthralgia and murmur. Echocardiography showed mild tomoderate mitral regurgitation. Later, the clinical course was complicated bypurpuric rash and abdominal pain. She was treated conservatively with IMpenicillin, acetylsalicylic acid and oral prednisolone. Our patient is the firstpatient with HSP and ARF who initially presented with features of ARF. Areview of literature revealed a limited number of cases of HSP associatedwith ARF (14 cases including the present case); and that the response totreatment in cases suffering from ARF associated with HSP was good; butone should also be aware of serious cardiac complications in HSP patientswhich may be fatal.

PDF

___

1. Brogan P, Bagga A. Leukocytoclastic vasculitis. In: Cassidy James T, Ross E, Ronald M, Carol B (ed). Textbook of Pediatric Rheumatology (6th ed). Philadelphia, PA: Saunders Elsevier, 2011: 483-497.

2. Gairdner D. The Schonlein-Henoch syndrome (Anaphylactoid purpura). Q J Med 1948; 17: 95-122.

3. Lopez-Herce Cid J, Cebrero Garcia M, Lopez de Sa E, Garcia de Frias E. Rheumatic fever associated with Schönlein-Henoch purpura. An Esp Pediatr 1993; 38: 568-570.

4. Mattoo TK, Al-Mutair A, Al-Khatib Y, Ali A, AlSohaibani MO. Group A beta-haemolytic streptococcal infection and Henoch-Schonlein purpura with cardiac, renal and neurological complications. Ann Trop Paediatr 1997; 17: 381-386.

5. Ocal B, Karademir S, Oguz D, Erdogan O, Oner A, Senocak F. Acute rheumatic carditis in Henoch-Scönlein purpura. Int J Cardiol 2000; 74: 97-98.

6. Eisentein EM, Navon-Elkan P. Acute rheumatic fever associated with Henoch-Schönlein purpura: Report of three cases and review of literature. Acta Paediatr 2002; 91: 1265-1267.

7. Gulati T, Kumar P, Dewan V, Anand VK. HenochSchönlein purpura with rheumatic carditis. Indian J Pediatr 2004; 71: 371-372.

8. Guven H, Ozhan B, Bakiler AR, Salar K, Kozan M, Bilgin S. A case of Henoch-Schönlein purpura and rheumatic carditis with complete atrioventricular block. Eur J Pediatr 2006; 165: 395-397.

9. Torres J, de Oliveira S, de Almeida R, Pelajo C, Sztajnbok F, Rodrigues MC. Acute rheumatic fever associated with Henoch-Schonlein purpura. Case report and review of the literature. Acta Reumatol Port 2007; 32: 377-380.

10. Sen TA, Kundak AA, Güraksın O, Demir T, Narcı A. Acute rheumatic carditis associated with SchoenleinHenoch vasculitis. Anadolu Kardiyol Derg 2010; 10: 465-466.

11. Special Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association. Guidelines for the diagnosis of rheumatic fever. Jones Criteria, 1992 update. JAMA 1992; 268: 2069-2073.

12. Ozen S, Pistorio A, Lusan SM, et al; Paediatric Rheumatology International Trials Organisation (PRINTO). EULAR/PRINTO/PRES criteria for Henoch-Schönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteria. Ann Rheum Dis 2010; 69: 798-806.

13. Robson WLM, Leung AKC. The frequency of preceding infection with group A beta-hemolytic streptococcus in patients with Henoch-Schonlein purpura. J Singapore Paediatr J 1993; 35: 168-172.

14. Shin JI, Kim JH, Lee JS, Kim DS, Choi JY, Sul JH. Cardiac manifestations of Henoch-Schoenlein purpura: IgA mediated vasculitis or Rheumatic fever? Eur J Pediatr 2007; 166: 627.

15. Osman A, McCreery CJ. Cardiac vasculitis in HenochSchonlein purpura. Circulation 2000; 101: E69-E70.

16. Kereiakes DJ, Ports TA, Finkbeiner W. Endomyocardial biopsy in Henoch-Schonlein purpura. Am Heart J 1984; 107: 382-385.

17. Kalyoncu M, Cakir M, Erduran E, Okten A. HenochSchonlein purpura: A case with atypical presentation. Rheumatol Int 2006; 26: 669-671.

18. Satoh M, Mikuniya A, Mikami M, et al. A case of Henoch-Schönlein purpura with myocardial complications. Kokyu To Junkan 1991; 39: 273-277.