Adult Henoch-Schonlein purpura associated with malignancy

Objective: Malignancies are among the well-established causes of vasculitis . We studied the association between adult Henoch-Schonlein purpura (HSP) a nd malignant neoplasms. Methods: We retrospectively reviewed 14 cases of adult HSP diagnosed during a 6-year period and found a malignant neoplasm in four. Fifteen reports of adult HSP with malignant disease were identified in the literature. These 19 cases were compared with 158 adults who had HSP but no malignancy and wh o where reported in the literature. Results: Most (63%) of the malignant neoplasms associated with adult HSP we re solid tumors: lung, n = 6; prostate, n = 2; breast, n = 1; renal, n = 1; stomach, n = 1; and small bowel, n = 1. Hematologic malignancies (37%) inc luded non-Hodgkin lymphoma, n = 2; Hodgkin disease, n = 2; IgA multiple mye loma, n = 1; myeloproliferative disease, n = 1; and myelodysplastic syndrom e, n = 1. Patients with malignancy were older (median age, 59 years), were more likely to be mate (M/F = 8.5), had joint involvement more frequently ( 95%), and had a lower frequency of prior acute infection than those without malignancy A typical paraneoplastic course was documented in only two case s. Conclusions. Epidemiological studies are needed to determine the associatio n between adult HSP and malignancy. In practice, it may be wise to suspect a malignancy in men older than 40 years of age who develop HSP in the absen ce of a precipitating factor. Pathogenic hypotheses involve tumor antigens or abnormal IgA production leading to immune complex formation. Copyright ( C) 2000 by W.B. Saunders Company.