Systemic Lupus Erythematosus and HenochSchönlein Purpura

Volume 6, Issue 4, April – 2021 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Systemic Lupus Erythematosus and Henoch-

Schönlein Purpura
Jaouad Yousfi*, Amal Elouakhoumi, Mouna Zahlane, Lamiaa Essaadouni
Department of Internal Medicine, University Hospital of Mohammed VI, Marrakesh, Morocco
Auteur correspondant*: Jaouad Yousfi, Department of Internal Medicine, University Hospital of Mohammed VI,
Marrakesh, Morocco
Abstract:- Systemic lupus erythematosus (SLE) is an The clinical examination revealed an apyretic patient,
autoimmune disease that can cause kidney damage. purpura (Figure1) and ecchymosis of the lower limbs,
However, lupus-unrelated renal injury has rarely been slightly infiltrated, not confluent and without necrotic
described in patients with SLE. We report the lesions. Ankle, knee and wrist joints were painful without
observation of a 28-year-old woman presenting with any osteoarticular deformities. Abdominal examination
vascular purpura, inflammatory joint pain and showed diffuse abdominal tenderness without
abdominal pain. The skin biopsy showed vasculitis while organomegaly. Cardiac and pulmonary auscultation were
direct immunofluorescence demonstrated IgA deposits. normal.
Two months later, the patient presented with malar rash
and lower limb edema. She tested positive for anti- The biological assessment showed a biological
nuclear antibodies (1/1280 with a homogeneous pattern) inflammatory syndrome, negative viral serologies (HIV,
and for anti-dsDNA (300 IU). Proteinuria was at Syphilis, CMV, hepatitis B and C). Elevated serum
4.18g/24h. Renal biopsy revealed proliferative immunoglobulin Aat 30 g/l (threshold of 10 U/ml). The skin
glomerulonephritis with IgA deposits. The diagnosis of biopsy showed vasculitis with IgA deposits. The diagnosis
SLE and IgA vasculitis with renal involvement was of IgA vasculitis (Henoch-Schönlein purpura) was
established. The patient was treated with corticosteroids established. The patient was treated with oral
and cyclophosphamide. corticosteroids(1mg/kg/day of prednisone) with clinical
improvement.
Keywords:- Systemic Lupus Erythematosus -IgA Vasculitis –
Nephropathy. Two months later, the patient presented with a malar
rash (Figure 2), a photosensitivity and an inflammatory
I. INTRODUCTION polyarthralgia. Clinical examination showededema of the
lower limbs, without purpura. The urine test strip was
Systemic lupus erythematosus (SLE) is an positiveforred blood cells (2x) and proteins (3x). The
autoimmune disease characterized by cutaneous and visceral biological assessment revealed lymphopenia at 810/mm3, C-
involvement. Lupus nephropathy is the most common reactive protein at 6 mg/l and erythrocyte sedimentation rate
visceral manifestation of systemic lupus. However, the of 23 mm. Antinuclear antibodies were positive at 1/1280
presence of renal involvement of other origin has been with a homogeneous fluorescence. Anti-dsDNA
reported in patients followed for SLE. Thus, IgA vasculitis werepositive at 300 (threshold of 24). Proteinuria was 4.18g
with renal involvement has been rarely associated with /day, albuminemia was at 35g/L and the renal function was
systemic lupus. We report a new observation of IgA normal (urea at 0.36 g/l andcreatinine at 8.2 mg/l). The renal
vasculitis nephropathy associated with systemic lupus biopsy showed a proliferative glomerular nephropathy with
erythematosus in a young woman. IgA deposition without IgM or IgG or C1q. The diagnosis of
IgA vasculitis nephritis associated with SLE was made.
II. CASE REPORT
In addition to the corticosteroid therapy, the patient
A twenty-eight-year-old patient presented with was treated with monthly intravenous bolus of
vascular purpura occurring four days before the admission, cyclophosphamide. The 6 months follow-up showed clinical
abdominal pain, bilateral and symmetrical inflammatory and biological improvement.
joints pain and diarrhea.
IJISRT21APR280 www.ijisrt.com 319

Volume 6, Issue 4, April – 2021 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
III. DISCUSSION
SLE is a chronic autoimmune disease affecting The distinction between IgA nephrotpathy and lupus
multiple organs. IgA vasculitis is a systemic small-vessel nephritis in SLE patients has important prognostic and
vasculitis which can affect different organs including the therapeutic implications5.
kidneys. It is aleukocytoclastic vasculitis characterized by
IgA1-immune deposits, complement factors and neutrophil IV. CONCLUSION
infiltration. This inflammation affects mainly dermal,
gastrointestinal and glomerular capillaries.1 Our observation highlights the importance of looking
for other etiologies of renal involvement in lupus patients.
IgA vasculitis is the most frequently encountered Although rare, IgA vasculitis with its renal involvement can
childhood vasculitis with an incidence of 10 cases per be associated with systemic lupus.
100,000 child population. In adults, it is rare with an
incidence of 3.4 to 14.3 cases per million. The clinical REFERENCES
presentation of IgA vasculitisis generally more severe in the
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Volume 6, Issue 4, April – 2021 International Journal of Innovative Science and Research Technology

Systemic Lupus Erythematosus and Henoch-

IJISRT21APR280 www.ijisrt.com 319

IJISRT21APR280 www.ijisrt.com 320

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