Henoch-Schönlein Purpura: A Rare Cause of Recurrent Acute Pancreatitis

Correspondence To the Editor: Henoch-Schönlein purpura (HSP) is a generalized vasculitis that can cause a large variety of symptoms in different organs. It usually presents as acute-onset palpable purpura mainly located on the lower extremities. Acute pancreatitis (AP) is a potentially life‑threatening inflammatory disorder and rarely presents as a complication of HSP. AP secondary to HSP is extremely rare, [3] and it is even rarer as an initial presenting feature of HSP before the occurrence of characteristic palpable purpura. We herein described a patient whose underlying HSP became clinically apparent after the development of AP. To the best of our knowledge, this is a very rare report of recurrent AP induced by HSP. A 57-year-old man was transferred to our pancreas center after 1 week of treatment for AP in a local hospital. He had severe colic and intermittent abdominal pain on admission. His blood pressure was 120/70 mmHg (1 mmHg = 0.133 kPa), body temperature was 36.8°C, and pulse was regular at 72 beats/min. No skin rash was observed. Abdominal examination revealed rebound tenderness in all quadrants. There was no hepatosplenomegaly, and bowel sounds were normal. There was no history of trauma, medication, chronic illness, or alcohol intake. The patient's family history was unremarkable. Abdominal computed tomography revealed effusion around the pancreatic head, thickened anterior fascia of the right kidney, and edematous swelling in the descending duodenum [Figure 1a]. He began conservative treatment for AP. On day 8, the patient developed an extended purpuric rash over his upper and lower extremities [Figure 1b and 1c]. He then underwent colonoscopy and gastroscopy because of a positive fecal occult blood test. Diffuse purpura was observed in his stomach, small intestine, and colon [Figure 1d-1f]. The patient was diagnosed with HSP complicated by AP. He began therapy with intravenous methylprednisolone (80 mg/d) for 3 days followed by oral prednisone (60 mg/d). The patient's clinical status quickly improved, and he was discharged on the 10 th day of treatment. Three months later, we discovered that the patient had been admitted to a local hospital because of recurrent AP and HSP. Unfortunately, the details of his admission were unavailable except that he was discharged 7 days after hospitalization. AP is a disease with a broad spectrum of etiologies. [4] Although most cases are secondary to biliary stones or alcohol abuse, other potential causes such as toxins, drugs, surgery, metabolic or autoimmune conditions, and infections …