Cerebral vasculitis in Henoch-Schonlein purpura: a case report with sequential magnetic resonance imaging changes and treated with plasmapheresis alone

Neurological complications are rare during the course of Henoch-Schonlein p urpura (HSP). We report a 7-year-old girl with HSP who presented with seizu res, loss of vision and disturbance of consciousness. Magnetic resonance im aging (MRI) showed high signal intensity in the gray and white matter over the left parietal and both occipital lobes, compatible with MRI findings of cerebral vasculitis. The eye fundi revealed multiple branches of retinal a rtery occlusion. Intravenous pulse methylprednisolone (MTP) followed by ora l steroid therapy was initially administered for HSP nephritis. Cerebral va sculitis developed 10 days post-MTP treatment, with progressive worsening o f consciousness. Oral steroid was discontinued and plasmapheresis was perfo rmed alone. Her level of consciousness dramatically improved after plasmaph eresis. The brain MRI and eye fundi findings were consistent with her clini cal improvement. To the best of our knowledge, this is the first descriptio n of MRI abnormalities and multiple retinal artery branch occlusion of cere bral vasculitis in a patient with HSP that was successfully treated by plas mapheresis alone. In conclusion, we propose that plasmapheresis may be used as a first-line therapy or rescue therapy for cerebral vasculitis in HSP.