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      Púrpura de Schönlein-Henoch en un adulto asociada a losartán Translated title: Schönlein-Henoch purpura in an adult associated with losartan

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          Abstract

          La púrpura de Schönlein-Henoch, es una vasculitis sistémica de pequeños vasos, con depósitos de IgA en las paredes vasculares, que se caracteriza clínicamente por: púrpura palpable, artritis o artralgias, dolor abdominal y compromiso renal. Es más frecuente en niños pero puede presentarse en adultos. La etiología es desconocida, pero se la ha relacionado a infecciones vacunas, fármacos y en adultos a neoplasias. Presentamos el caso de una mujer de 74 años, que había comenzado a tomar losartán diez días previos al comienzo de los síntomas. Para normalización de la tensión arterial, se suspendió el losartán. Al reiniciar la droga, la paciente presentó nuevamente una púrpura palpable, en miembros inferiores.

          Translated abstract

          Schönlein-Henoch purpura is a systemic vasculitis of small vessels with IgA deposits in vessel walls. It presents with palpable purpura, arthritis or arthralgia, abdominal pain and renal involvement. It is more common in children, but it can also be seen in adults. Although, the etiology is unknown, the illness has been associated with infections, vaccines, drugs and, in adults, with neoplasias, as well. A 74 year-old woman who had started taking losartan ten days before she started with the onset of symptoms are reported. Days after, the arterial tension normalized, so losartan was suspended. When the drug was reintroduced, the patient presented once again a palpable purpura on lower limbs.

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          Most cited references19

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          Henoch-Schönlein Purpura in adults: outcome and prognostic factors.

          Henoch-Schönlein Purpura nephritis (HSPN) has been extensively studied in children but, its natural history in adults is much less known. A cohort of 250 adults suffering HSP was retrospectively analyzed for a median follow-up period of 14.8 yr. All patients had biopsies consistent with HSP (predominant IgA mesangial deposits) associated with purpura, bowel angina, and/or abdominal pain. At presentation, palpable purpura was present in 96% of patients, and arthritis was reported in 61%, and gastrointestinal involvement in 48%. Thirty-two percent of the patients showed renal insufficiency (Creatinine clearance [CrCl] <50 ml/min), usually associated with proteinuria (99%) and/or hematuria (93%). Endocapillary glomerulonephritis was the most frequent lesion on renal biopsy (61%). At the end of follow-up, patient survival was only 74%. The first cause of death was carcinoma (most of them of respiratory or digestive tract). Regarding renal function, 11% of patients reached end-stage renal failure, 13% exhibited severe renal failure (CrCl <30 ml/min), and 14% moderate renal insufficiency (CrCl <50 ml/min). Clinical remission defined as the absence of proteinuria, hematuria, and a normal renal function was achieved in only 20%. This is a retrospective study; therefore, it is not possible to demonstrate any steroid and/or cyclophosphamide efficacy in diminishing the incidence of renal insufficiency. Multivariate analysis demonstrated that renal function impairment and proteinuria level at presentation and, on renal biopsy, the degree of interstitial fibrosis, percentage of sclerotic glomeruli, and presence of glomeruli with fibrinoid necrosis were associated with a poor renal prognosis. The data indicate that clinical presentation of HSPN in adults is severe and its outcome relatively poor, worse than in children. Identification of clinical and histologic prognostic factors may permit the design of appropriate therapeutic prospective studies.
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            Henoch-Schönlein purpura associated with malignancy in adults.

            Malignancy is a well-known cause of cutaneous vasculitis. The occurrence of neoplasia and Henoch-Schönlein purpura (HSP) is rare and poorly understood in adults. A total of 31 cases have been reported in the world literature of adult malignancy-associated HSP. Patients were overwhelmingly male (94%) with a mean age of 60 years and presented predominantly with solid tumors (61%). The most frequent tumors were lung (nonsmall-cell) (n = 8), multiple myeloma (n = 5), prostate (n = 5), and non-Hodgkin's lymphoma (n = 3). The majority of patients (55%) developed HSP within 1 month of cancer diagnosis or detection of metastases. We present 3 cases of adults who, in the absence of known precipitating factors, developed HSP within 2 months of diagnosis of a solid tumor or metastases. We recommend that adults, especially older men who present with unexplained HSP, be evaluated for occult neoplasm. We also advise that patients with a known history of malignancy who present with HSP be evaluated for metastatic disease.
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              A clinical study of Henoch-Schönlein Purpura associated with malignancy.

              Malignancy has been reported as a causative factor of cutaneous vasculitis, although only two retrospective epidemiological studies have analysed the association between Henoch-Schönlein purpura (HSP) and malignancy to date. To analyse the association between adult HSP and malignancy. We retrospectively reviewed the medical records of patients and found 103 cases of HSP over the past 20 years. Fifty-three cases (aged > or = 41 years) were categorized to two groups including 'with malignancy' or 'without malignancy', so that we could analyse the differences of clinical features between them. We also compared our study to previous reports. Twenty-three cases out of 53 patients exhibited underlying malignant tumours. We focused on nine patients in which malignant tumours were thought to be strongly associated. Seven of nine patients exhibited new metastatic lesions or died due to underlying cancer within 1-32 months. An association between HSP and malignant disease might have important diagnostic and pathophysiologic implications.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rad
                Revista argentina de dermatología
                Rev. argent. dermatol.
                Asociación Argentina de Dermatología (Ciudad Autónoma de Buenos Aires, , Argentina )
                1851-300X
                September 2016
                : 97
                : 3
                : 27-33
                Affiliations
                [03] orgnameUniversidad Católica de Córdoba orgdiv1Carrera en Dermatología
                [01] Córdoba orgnameHospital Privado Universitario de Córdoba orgdiv1Servicio de Dermatología Argentina
                [02] orgnameHospital Privado Universitario de Córdoba orgdiv1Servicio de Patología
                Article
                S1851-300X2016000300005
                3a8276ca-3867-4b18-b9e7-9a5316f38467

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 11 June 2016
                : 16 August 2016
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 19, Pages: 7
                Product

                SciELO Argentina


                púrpura de Schönlein-Henoch,vasculitis de pequeños vasos,losartán,Schönlein-Henoch purpura,small vessel vasculitis,losartan

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