Cardiopulmonary manifestations of Henoch-Schonlein Purpura

Henoch-Schonlein Purpura (HSP) is usually a mild condition involving the sk in, gut, joints, and kidneys and has a good prognosis. We present a 63-year -old Hispanic man who had an unusually severe form of HSP with a fatal outc ome attributable to vasculitis causing myocardial necrosis, There is only o ne citation in the literature of HSP-related myocardial vasculitis, which i nvolved the right ventricle and was successfully treated with steroids. Our patient had severe HSP-related myocardial necrosis, tracheobronchitis, and nephritis, The bronchial lesions resolved, presumably because of steroid t herapy. This probably is the first case of fatal myocardial necrosis relate d to HSP, We conclude that HSP can, in some cases, have an aggressive cours e. It becomes imperative to recognize the involvement of the other organ sy stems, such as the heart, so that appropriate therapy may be initiated. Imm unosuppression may have a beneficial effect on extrarenal lesions. Controll ed clinical trials are needed to establish the efficacy of such treatment. (C) 2000 by the National Kidney Foundation, Inc.