Case report
Henoch-Schönlein purpura with intracerebral haemorrhage in an adult patient: a case report
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* Corresponding author: Lazarus Karamadoukis lazarus.karamadoukis@nbt.nhs.uk
1 The Richard Bright Renal Unit, Southmead Hospital, Westbury upon Trym, Bristol, BS10 5NB, UK
2 Department of Histopathology, Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK
3 Cotswold Dialysis Centre, Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK
Journal of Medical Case Reports 2008, 2:200 doi:10.1186/1752-1947-2-200
Published: 12 June 2008Abstract
Introduction
Henoch-Schönlein purpura is a small vessel vasculitis that affects mainly the skin, joints, gastrointestinal tract and kidneys. The central nervous system is also occasionally affected, although the majority of patients experience only mild symptoms such as headaches and behavioural changes. Intracerebral haemorrhage is a rare complication of Henoch-Schönlein purpura that so far has mainly been described in children and young adolescence.
Case presentation
We describe a 42-year-old man with Henoch-Schönlein purpura who developed an acute intracerebral haemorrhage that coincided with a reactivation of his vasculitis and the development of renal failure following discontinuation of steroids. In this patient, both the Henoch-Schönlein purpura and his neurological symptoms were successfully treated with intravenous cyclophosphamide and methylprednisolone, followed by a short course of oral cyclophosphamide and long-term oral prednisolone. His renal function also recovered sufficiently not to require renal replacement therapy.
Conclusion
The management of Henoch-Schönlein nephritis remains unclear, especially in the presence of severe complications such as intracerebral haemorrhage. We describe a successful outcome in such a patient.