Henoch-Schonlein 자반증의 임상적 고찰

Abstract

Background: Henoch-Schonlein purpura is a relatively common dermatological disease involving multisystems such as the skin, gastrointestinal tract, joints, kidnies. there have been several reports on the epidemiological study of Henoch-Schonlein purpura in Korea. However, there has not been any report on the clinical analysis of Henoch-Schonlein purpura in domestic dermatological journals. Objective: The aim of this study was to analyze clinical symptoms of Henoch-Schonlein purpura defined by strict application of the American College of Rheumatology 1990 criteria with a dermatologist's point of view. Methods: The authors analyzed retrospectively 60 cases of Henoch-Schonlein purpura selected by age($lt; 20) and histopathological findings of the skin showing leukocytoclastic vasculitis or granulocytes in the wall of small vessels among the 137 patients hospitalized with Henoch-Schonlein purpura at Keimyung University Hospital from March, 1993 to February, 1998. Results: 1. It was observed more frequently in males as the sex ratio of 1.6:1. The most prevalent age group was 5 to 7-year-olds(36.7%) and children of 2 to 10-year-old represented 66.7% of the total cases. 2. In seasonal incidence, the cases were frequent during autumn(34%) and winter(25%). 3. No pecific history was noted in 22 cases(37%). The main specific histories were upper respiratory tract infections(32%) and drugs(12%). 4. The clinical manifestations showed in the skin(100%), the gastrointestinal tract(52%), the joints(43%), kdnies(27%) respectively. 1) The common manifestation in the skin was purpuric papule and petechiae(97%) and the lower extremities were involved in all cases. Moreover, the lower extremities and buttocks were the most common involved sites. 2) As for the gastrointestinal symptoms, abdominal pain was noted in all cases and others were occult blood(52%), nausea(23%), diarrhea(6%) and melena(6%). Abnormal gastrointestinal endoscopic findings were noted in 28 cases(90%) and duodenum was involved in 93% of 28 cases. 3) Arthralgia was observed on the knee joint(65%), ankle joint(50%), elbow joint(15%). More than 2 joints were involved in 38% of cases. 4) Renal manifestations were proteinuria(94%), microscopic hematuria(81%), gross hematuria(19%) and hypertension(2%). A Renal biopsy done in 2 cases revealed mesangial proliferative glomerulonephritis with the deposition of IgA. 5. Platelet count and blood coagulation tests were within normal ranges. Observed abnormal laboratory findings were leukocytosis(70%), increased ESR(77%), elevated ASO titer(37%), elevated serum IgA(50%), elevated C3(38%), positive antinuclear antibody(10%). There was no statistical significance betyween the renal involved group and the non-involved group in terms of ASO titer and serum IgA(p�0.05). 6. Skin, abdominal and joint manifestations recovered within 1 month except 1 case with skin involvement. Among the 16 cases with renal involvement, 10 cases(62%) recovered within 2 months and 2 cases(13%) showed persistent symptoms over 1 year. One case progressed to nephrotic syndrome. Conclusion: Most of our results were similar with previous reports and the prognosis of Henoch-Schonlein purpura was good. In some cases, gastrointestinal endoscopy may be helpful for evaluating the bowel manifestation and early diagnosis. Because the long-term prognosis for patients with renal involvement depends on the initial clinical presentation, early diagnosis and prompt proper management through cooperation with other departments is important and long-term follow-up is necessary even if clinical manifestations are recovered, especially in patients with renal involvement.