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• W2079504129 abstract "HomeCirculationVol. 101, No. 5Cardiac Vasculitis in Henoch-Schönlein Purpura Free AccessOtherPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessOtherPDF/EPUBCardiac Vasculitis in Henoch-Schönlein Purpura Abdulfatah Osman and Charles J. McCreery Abdulfatah OsmanAbdulfatah Osman From the Division of Cardiology, University of Texas, Galveston. Search for more papers by this author and Charles J. McCreeryCharles J. McCreery From the Division of Cardiology, University of Texas, Galveston. Search for more papers by this author Originally published8 Feb 2000https://doi.org/10.1161/01.CIR.101.5.e69Circulation. 2000;101:e69–e70A63-year-old man presented with a 1-week history of bloody diarrhea, abdominal pain, nausea, arthralgias, and fatigue. Physical examination revealed an acutely ill patient with a distended, tender abdomen. A purpuric skin rash was noted on the extremities and trunk (Figure 1). Laboratory tests showed leukocytosis, proteinuria, and elevated creatinine. A skin biopsy revealed small-vessel neutrophilic vasculitis. Immunofluorescence was positive for multifocal IgA deposits along the walls of dermal vessels (Figure 2). High-dose prednisone and azathioprine were started. On hospital day 4, the patient developed slow junctional rhythm with hypotension requiring transvenous ventricular pacing. Serum cardiac troponin T was elevated. Sinus rhythm never recovered, and ectopic low atrial rhythm predominated (Figure 3). The subsequent course was marked by worsening renal failure, noncardiogenic pulmonary edema, and respiratory failure. The patient died despite maximal supportive care. At autopsy, the heart showed confluent ecchymoses involving the entire right atrium (Figure 4). Multiple sections from the atrium, including the area of the sinoatrial node, showed neutrophilic myocarditis and diffuse small-vessel leukocytoclastic vasculitis with fibrinoid necrosis (white arrow) and interstitial hemorrhages (black arrow) (Figure 5). The cardiac chambers and great vessels were spared. Other findings included intestinal serosal hemorrhages, bronchial mucosal ecchymoses, and focal segmental glomerulonephritis positive for IgA deposits. The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.Download figureDownload PowerPoint Figure 1. Confluent purpuric skin lesions involving toes and distal part of foot.Download figureDownload PowerPoint Figure 2. Immunofluorescence examination shows strong positivity for IgA deposits in walls of dermal small vessels.Download figureDownload PowerPoint Figure 3. Rhythm strip from lead II showing ectopic atrial rhythm.Download figureDownload PowerPoint Figure 4. Exposed endocardial surface of right atrium and ventricle shows diffuse, confluent, subendocardial hemorrhages involving entire right atrium. Ecchymotic endocardium is sharply demarcated at tricuspid ring and at inlets of vena cava.Download figureDownload PowerPoint Figure 5. Hematoxylin-eosin–stained sections from right atrium showing necrotizing leukocytoclastic vasculitis of a small atrial vessel. Neutrophilic infiltrate and nuclear debris are seen in and around necrotic vessel (white arrow). Interstitial hemorrhages are present in background (black arrow).FootnotesCorrespondence to Charles J. McCreery, MD, FACC, University of Texas, 301 University Blvd, Galveston, TX 77555-0553. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Yılmaz N, Yüksel S, Becerir T, Girişgen İ, Ufuk F, Gürses D, Yılmaz M and Yalçın N (2020) Myocarditis and intracardiac thrombus due to Henoch-Schönlein purpura: case report and literature review, Clinical Rheumatology, 10.1007/s10067-020-05317-8, 40:4, (1635-1644), Online publication date: 1-Apr-2021. Lee K, Kronbichler A, Eisenhut M, Lee K and Shin J (2018) Cardiovascular involvement in systemic rheumatic diseases: An integrated view for the treating physicians, Autoimmunity Reviews, 10.1016/j.autrev.2017.12.001, 17:3, (201-214), Online publication date: 1-Mar-2018. Bloom J, Darst J, Prok L and Soep J (2018) A case of Henoch-Schonlein Purpura with dilated coronary arteries, Pediatric Rheumatology, 10.1186/s12969-018-0270-9, 16:1, Online publication date: 1-Dec-2018. Torosoff M, Breen T, Balulad S, Padala S, Lyubarova R, Tan H and Sidhu M (2018) Resolution of sinus bradycardia, high-grade heart block, and left ventricular systolic dysfunction with rituximab therapy in Henoch-Schonlein purpura, Internal Medicine Journal, 10.1111/imj.13948, 48:7, (868-871), Online publication date: 1-Jul-2018. Sebastiani M, Manfredi A and Ferri C (2017) Cardiac Involvement in Systemic Vasculitis The Heart in Systemic Autoimmune Diseases, 10.1016/B978-0-12-803997-7.00014-4, (335-382), . Canpolat U, Yorgun H, Şahiner L and Kabakçi G (2012) Myocardial infarction due to coronary thrombosis in a patient with Henoch–Schönlein purpuraMyokardinfarkt durch Koronarthrombose bei einem Patienten mit Purpura Schönlein-Henoch, Herz, 10.1007/s00059-012-3597-x, 37:7, (801-803), Online publication date: 1-Nov-2012. Lutz H, Ackermann T, Krombach G, Gröne H, Rauen T, Floege J and Mertens P (2009) Henoch-Schönlein Purpura Complicated by Cardiac Involvement: Case Report and Review of the Literature, American Journal of Kidney Diseases, 10.1053/j.ajkd.2009.04.017, 54:5, (e9-e15), Online publication date: 1-Nov-2009. Goon S, Sathishkumar S, Siggers B and Sadler P (2016) A Case of Henoch-Schonlein Purpura with Multi-System Complications, Journal of the Intensive Care Society, 10.1177/175114370700800124, 8:1, (60-62), Online publication date: 1-Apr-2007. Eleftheriadis D (2007) Severe coronary artery disease in the setting of Henoch–Schoenlein purpura, International Journal of Cardiology, 10.1016/j.ijcard.2006.07.023, 118:2, (262-263), Online publication date: 1-May-2007. Shin J, Kim J, Lee J, Kim D, Choi J and Sul J (2006) Cardiac manifestations of Henoch-Schoenlein purpura: IgA mediated vasculitis or Rheumatic fever?, European Journal of Pediatrics, 10.1007/s00431-006-0273-2, 166:6, (627-627), Online publication date: 19-Apr-2007. Güven H, Özhan B, Bakiler A, Salar K, Kozan M and Bilgin S (2006) A case of Henoch-Schönlein purpura and rheumatic carditis with complete atrioventricular block, European Journal of Pediatrics, 10.1007/s00431-006-0094-3, 165:6, (395-397), Online publication date: 1-Jun-2006. Polizzotto M, Gibbs S, Beswick W and Seymour J (2006) Cardiac involvement in Henoch-Schonlein purpura, Internal Medicine Journal, 10.1111/j.1445-5994.2006.01061.x, 36:5, (328-331), Online publication date: 1-May-2006. Eisenstein E and Navon-Elkan P (2007) Acute rheumatic fever associated with Henoch-Schönlein purpura: report of three cases and review of the literature, Acta Paediatrica, 10.1111/j.1651-2227.2002.tb00141.x, 91:11, (1265-1267) BALKIR F, CEVİZ N, LALOĞLU F and OLGUN H (2021) The Frequency of Cardiac Involvement in Children with Henoch-Schonlein Purpura, Ahi Evran Medical Journal, 10.46332/aemj.909960 Kang Z, Wu W, Xun M, Ding Y and Li Z (2022) Henoch-Schönlein Purpura /IgA Vasculitis Complicated by Coronary Artery Aneurysm: A Case Report and Literature Review, Frontiers in Pediatrics, 10.3389/fped.2021.781106, 9 February 8, 2000Vol 101, Issue 5 Advertisement Article InformationMetrics Copyright © 2000 by American Heart Associationhttps://doi.org/10.1161/01.CIR.101.5.e69 Originally publishedFebruary 8, 2000 PDF download Advertisement" @default.
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