Introduction:

Henoch-Schonlein purpura (HSP) is a rare vasculitis primarily affecting small blood vessels in children, leading to inflammation and damage. It manifests with characteristic symptoms involving the skin, joints, gastrointestinal (GI) tract, and kidneys. While uncommon in adults, HSP can occur and may be associated with various triggers, including infections like Helicobacter pylori (HP). This case report details a unique presentation of HSP in an adult patient potentially triggered by HP infection.

Detailed Explanation of Terms and Events:

• Henoch-Schonlein Purpura (HSP): An autoimmune condition causing inflammation of small blood vessels. This leads to:
  • Leukocytoclastic vasculitis: Inflammation with destruction of white blood cells within the vessel walls.
  • Skin involvement: Palpable purpuric rash, typically on the buttocks and legs.
  • Joint involvement: Pain, swelling, and tenderness in the joints.
  • Gastrointestinal involvement: Abdominal pain, nausea, vomiting, or blood in stool.
  • Renal involvement: Blood or protein in the urine, potentially leading to kidney complications.
• Helicobacter pylori (HP): A bacterium that can colonize the stomach lining and cause chronic inflammation, leading to peptic ulcers and other GI issues.

Case Presentation:

• Patient: A 30-year-old Indian man with no significant medical history except controlled psoriasis.
• Symptoms: Sudden onset of constant right upper quadrant abdominal pain for five days.
• Initial Evaluation:
  • Blood tests: Elevated white blood cell count (leukocytosis) indicating inflammation.
  • Imaging studies: Normal results, excluding other causes of abdominal pain.
  • Initial diagnosis and treatment: Discharged with medications for stomach acid reduction and pain management.
• Progression:
  • Persistent abdominal pain despite treatment.
  • Development of a new maculopapular rash on both legs.
• Further Investigation:
  • Upper endoscopy: Revealed a small non-bleeding gastric ulcer and multiple duodenal erosions.
  • Gastric biopsy: Confirmed HP infection.
  • Skin biopsy: Confirmed leukocytoclastic vasculitis, indicative of HSP.
• Diagnosis and Treatment:
  • HSP diagnosed by excluding other causes and based on characteristic clinical features.
  • Treatment initiated with:
    • Antibiotic combination to eradicate HP infection.
    • Prednisone, a corticosteroid, to suppress inflammation and manage HSP symptoms.
• Outcome:
  • Significant improvement in symptoms within a day of starting prednisone.
  • Gradual steroid taper over eight weeks.
  • Complete resolution of both abdominal pain and skin rash.

Discussion:

• This case highlights the rare occurrence of HSP in adults and its potential association with HP infection.
• While the exact link between HP and HSP remains unclear, some studies suggest HP may trigger the immune response leading to vasculitis in susceptible individuals.
• The case emphasizes the importance of considering HP infection in HSP patients, especially in regions with high HP prevalence.
• Eradicating HP infection can significantly improve HSP symptoms and potentially prevent complications.
• Corticosteroids, like prednisone, are often used to manage inflammation and improve symptoms in severe HSP cases.

Conclusion:

This case report contributes to the understanding of HSP in adults and its potential association with HP infection. Early diagnosis, HP eradication, and appropriate management with corticosteroids can lead to favorable outcomes in such cases. Further research is needed to elucidate the underlying mechanisms linking HP and HSP.