Systemic lupus erythematosus with initial manifestation of Henoch-Schönlein purpura: A case report and literature review
Main Article Content
Abstract
Henoch-Schönlein purpura (HSP) is the most common vasculitis in children, characterized by a typical purpuric rash combined with digestive, joint, and kidney symptoms. Systemic lupus erythematosus (SLE) is an autoimmune systemic disease that can also affect organs similar to those affected in HSP - cutaneous vasculitis, joints, and kidneys - however treatment for each condition differs. Few cases linking HSP and SLE have been reported. We report a case of a 13-year-old girl with the typical purpuric rash of HSP and signs of kidney damage in urinalysis (hematuria and proteinuria) but was ultimately diagnosed with lupus nephritis. Although rare, in patients presenting with symptoms of HSP, clinicians should also consider the possibility of overlapping with manifestations of SLE to ensure an appropriate diagnosis and treatment plan.
Article Details
Keywords
Henoch-Schönlein purpura, systemic lupus erythematosus, nephritis, children
References
2. Maryam Piram, Carla Maldini, Sandra Biscardi, et al. Incidence of IgA vasculitis in children estimated by four-source capture-recapture analysis: a population-based study. Rheumatology (Oxford). 2017;56(8):1358-1366. doi: 10.1093/rheumatology/kex158
3. Trnka P. Henoch–Schönlein purpura in children. Journal of Paediatrics and Child Health. 2013;49(12):995-1003. doi:10.1111/jpc.12403
4. Benseler SM, Silverman ED. Systemic Lupus Erythematosus. Pediatric Clinics of North America. 2005;52(2):443-467. doi:10.1016/j.pcl.2005.01.010
5. Pinheiro SVB, Dias RF, Fabiano RCG, et al. Pediatric lupus nephritis. J Bras Nefrol. 2019;41(2):252-265. doi:10.1590/2175-8239-JBN-2018-0097
6. Aringer M, Costenbader KH, Daikh DI, et al. 2019 EULAR/ACR Classification Criteria for Systemic Lupus Erythematosus. Arthritis Rheumatol. 2019;71(9):1400-1412. doi:10.1002/art.40930
7. Al-Attrach I, Al-Shibli A, Al-Riyami L, et al. Systemic lupus erythematosus with severe nephritis that mimicked Henoch-Schoenlein purpura. Arab J Nephrol Transplant. 2011;4(3):159-161. doi:10.4314/ajnt.v4i3.71029
8. Abdwani R, Abdalla E, El-Naggari M, et al. Henoch-Schonlein purpura with lupus-like nephritis: an uncommon occurrence. International Journal of Rheumatic Diseases. 2017;20(11):1853-1855. doi:10.1111/1756-185X.12461
9. Hu P, Huang BY, Zhang DD, et al. Henoch-Schönlein purpura in a pediatric patient with lupus. Arch Med Sci. 2017;13(3):689-690. doi:10.5114/aoms.2017.67288
10. Murata C, Rodríguez-Lozano AL, Hernández-Huirache HG, et al. IgA vasculitis (Henoch – Schönlein Purpura) as the first manifestation of juvenile Systemic Lupus Erythematosus: Case-control study and systematic review. BMC Pediatrics. 2019;19(1):461. doi:10.1186/s12887-019-1829-4
11. Lucas M, Dias S. Systemic lupus erythematosus simulating Henoch Schonlein purpura. Sri Lanka J Child Health. 2008;36(4):142. doi:10.4038/sljch.v36i4.76