FIRST SIGNS OF SCHONLEIN-HENOCH PURPURA I N A 74-YEAR-OLD-WOMAN WITH HYPERTHYROIDISM

History and clinical findings: A 74-year-old woman had for 3 weeks suf fered from watery diarrhoea and diffuse abdominal pain. She felt restl ess, had a subfebrile temperature (37.8 degrees C), tachycardia and a blood pressure of 190/90 mm Hg. Shortly after admission petechiae were found over the lower legs and she complained of joint pains. Investig ations: Laboratory tests established hyperthyroidism. Skin biopsy show ed leucocytoclastic vasculitis. Tests for antinuclear antibodies, anti streptolysin titre, rheumatoid factors, cryoglobulins and TSH-receptor antibodies were negative, immunoglobulin A (IgA) was raised. Treatmen t and course: As a drug-induced vasculitis was suspected treatment was started with methylprednisolone, 100 mg daily. Proteinuria (5.69 dail y) indicated renal biopsy, which revealed focal glomerulonephritis wit h deposits of IgA, fibrin/fibrinogen and complement factor 3. Gastrosc opic biopsy, performed after an episode of gastrointestinal bleeding, demonstrated necrotizing vasculitis, confirming the diagnosis of Schon lein-Henoch-purpura (SHP). As the patient's condition rapidly worsened , cyclophosphamide was started additionally (2 mg/kg). She died on the 17th hospital day from acute cardiac failure. Conclusion: The lethal course of the disease in this elderly patient illustrates a previously not reported close temporal and clinical relationship between SHP and hyperthyroidism.