Schonlein-Henoch purpura

The ACE gene encodes two isozymes (somatic ACE isozyme and germinal ACE isozyme). ACE is a membrane-bound enzyme on the surface of vascular endothelial cells that also circulates in plasma and shows great individual variability determined by an I/D polymorphism in intron 16 of the ACE gene (ACE-I/D polymorphism). More than 160 ACE polymorphisms have been reported, 34 of which are located in coding regions, and 18 are missense mutations (606). ACE-related polymorphic variants have been associated with hypertension, atherosclerosis, stroke, left ventricular hypertrophy, chronic renal failure in IgA nephropathy, Henoch-Schonlein purpura nephritis, mechanical efficiency of skeletal muscle, intracranial aneurysms, susceptibility to myocardial infarction, diabetic nephropathy, AD, and longevity (12,606,607). 

III.b.2. IgA Nephropathy (Berger s Disease) and Henoch—Schonlein Purpura... 

Bergstein J, Leiser J, Andreolli SP. Response of crescentic Henoch-Schonlein purpura nephritis to corticosteroid and azathioprine therapy. Clin Nephrol 1998 49 9-14. 

A 67-year-old woman developed Henoch-Schonlein purpura, with a leukocytoclastic vasculitis and joint pains, after taking anastrozole for 10 months the symptoms resolved within 2 weeks of withdrawal (34). 

A 30-year-old man developed destructive rhinitis due to cocaine abuse after initially presenting with Henoch-Schonlein purpura (121). Cocaine use can mimic vasculitis and is often accompanied by positive ANCAs. Cocaine-induced midline destructive lesions are characterized by mucosal damage and ischemic necrosis of the nasal septum. Histopathological similarity to leukocytoclastic vasculitis and the presence of PR3-ANCA can lead to confusion between Wegener s granulomatosis and cocaine-induced midline destructive lesions. 

Sola Alberich R, Jammoul A, Masana L. Henoch-Schonlein purpura associated with acetylsalicylic acid. Ann Intern Med 1997 126(8) 665. 

Some 15 cases of thrombocytopenia, reversible after withdrawal of carbamazepine, have been published (SED-13, 147) (41,42). There have also been single case reports of reticulocytosis (SED-13,147) (43), leukopenia with thrombocytopenia with Henoch-Schonlein purpura (SEDA-18,63), hemolytic anemia, and pure red cell aplasia (SED-13,147) (44). 

Adult Henoch-Schonlein purpura has been attributed to enalapril (10). 

Henoch-Schonlein purpura, possibly caused by topical lindane, has been described (12). 

Fagan JE. Henoch-Schonlein purpura and gamma-benzene hexachloride. Pediatrics 1981 67(2) 310-11. 

Goldberg El, Shoji T, Sapadin AN. Henoch-Schonlein purpura induced by clarithromycin. Int J Dermatol 1999 38(9) 706-8. 

Hematuria with purpuric rash and Henoch-Schonlein purpura have been described (13). 

Glomerulonephritis has been reported in association with Henoch-Schonlein purpura (46) and nephrotic syndrome, possibly as part of a lupus-like syndrome (47). 

Other patients have the typical picture of serum sickness, sometimes associated with acute renal insufficiency (68-70) or of Henoch-Schonlein purpura (71) with a purpuric rash, joint and abdominal pains, and sometimes hematuria (72). 

Lee A, Kasama R, Evangelista A, Elfenbein B, Falasca G Henoch-Schonlein purpura after etanercept therapy for psoriasis, J Clin Rheumatol 2006,12 249-251... 

Bachmeyer C +, J Eur Acad Dermatol Venereol 21 (4), 550 Henoch-Schonlein purpura... 

Dellaripa PF +, Mayo Clin Proc 75(6), 643 Henoch-Schonlein purpura... 

Several other disorders have been reported in association with vkAT deficiency, although many of these may be no more than chance occurrences. However, it appears that the risk for development of systemic vasculitic disease, including Wegener s granulomatosis and Henoch-Schonlein purpura, may be increased in deficient individuals. 

Primary IgA nephropathy an immune-complex-mediated disease in which IgA deposits and other pathologic lesions are found in kidney tissues. In contrast, Henoch-Schonlein purpura is a systemic disease that is believed to be closely linked to IgA nephropathy because they share similar immunohistologic features. Only the joints, skin, and gastrointestinal tract are affected in Henoch-Schonlein purpura. Mesangial deposition of IgA immune complex is also seen in patients with celiac disease and dermatitis herpetiformis, possibly due to an increased exposure to antigens. Patients with chronic liver disease may have IgA nephropathy because of reduced clearance of IgA immune complexes. Secondary IgA nephropathy may be present in patients with different connective tissue diseases, carcinomas, and HIV infection. 

Rashes of aU types may be caused by allergy to peniciUin. Henoch-Schonlein purpura with renal involvement has been a rare complication. Contact dermatitis is observed occasionally in pharmacists, nurses, and physicians who prepare penicilUn solutions. Fixed-drug reactions also have occurred. More severe reactions involving the skin are exfoliative dermatitis and exudative erythema multiforme. The incidence of rashes appears to be highest foUowing the use of ampicUlin ( 9%) rash follows the administration of ampiciUin in nearly all patients with infectious mononucleosis. 

AITD, autoimmune thyroid disease ALPS, autoimmune lymphoproliferative syndrome AS, ankylosing spondylitis CD, celiac disease HSP, Henoch-Schonlein purpura MG, myasthenia gravis RA, rheumatoid arthritis TID, type 1 diabetes. 

Two cases of Henoch-Schonlein purpura (a disease that involves purple spots on the skin, joint pain, and... 

Two cases of Henoch-Schonlein purpura (a disease that involves purple spots on the skin, joint pain, gastrointestinal problems, and glomerulonephritis) have been reported in individuals that were using aloe. One patient had taken "some juice extracted from four to five leaflets of Aloe vera" (he had taken the same remedy several months prior with no reaction) 24 hours prior to developing a rash, abdominal pain followed by rapid deterioration of renal function and abnormal levels of serum creatinine (Cholongitas et al. 2005). The second patient had taken "extracts of Aloe vera" (parts consumed and dose consumed unspecified) for approximately 1 week. He developed general edema and palpable purpura that eventually resolved (Cao et al. 2005). 

Cholongitas E., Katsoudas, S., and Dourakis, S. 2005. Henoch-Schonlein purpura associated with Aloe vera adrninistratiorL Eur. J. Intern. Med. 16(l) 59-60. 

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