Plasma exchange therapy for severe gastrointestinal involvement of Henoch Schönlein purpura in children.

Abstract

OBJECTIVES:

The aim of this report is to evaluate the plasma exchange as a choice for the management of life-threating gastrointestinal system (GIS) involvement in Henoch-Schönlein purpura (HSP) when refractory to conventional therapies.

METHODS:

We retrospectively reviewed the medical records of HSP patients who had plasma exchange therapy due to massive GIS involvement. We reported age, gender, initial HSP presentation, etiological or triggering factors and disease course. Treatment modalities, side effects and their outcomes were noted.

RESULTS:

We reported 7 cases of childhood HSP with severe gastrointestinal involvement refractory to common immunosuppression with systemic steroid and cytotoxic therapy. All patients gave inadequate response to pulse methyl prednisolone or oral prednisolone therapy with ongoing GIS bleeding and severe abdominal pain. Therefore, pulse cyclophosphamide was added to the treatment. Two patients received additional intravenous immunoglobulin (IVIG) therapy. Gastrointestinal manifestations continued and plasma exchange was performed. All patients improved after plasma exchange treatment.

CONCLUSIONS:

Treatment of GI involvement in HSP with plasma exchange has been mainly based on case reports. According to our data, we propose that, plasma exchange may be a safe and efficient management choice in paediatric HSP patients with massive GIS involvement that are refractory to other therapies.

• Authors: Ö Başaran, N Cakar, N Uncu, B A Çelikel, A Kara, F S Cayci, A Taktak, G Gür
• Journal: Clinical and experimental rheumatology (Clin Exp Rheumatol) 2015 Mar-Apr Vol. 33 Issue 2 Suppl 89 Pg. S-176-80 ISSN: 0392-856X [Print] Italy
• PMID: 25436762 (Publication Type: Journal Article)

Chemical References

• Immunoglobulins, Intravenous
• Immunosuppressive Agents
• Cyclophosphamide
• Methylprednisolone

Topics

• Abdominal Pain (etiology, therapy)
• Adolescent
• Child
• Child, Preschool
• Cohort Studies
• Cyclophosphamide (therapeutic use)
• Female
• Gastrointestinal Diseases (etiology, therapy)
• Gastrointestinal Hemorrhage (etiology, therapy)
• Humans
• IgA Vasculitis (complications, therapy)
• Immunoglobulins, Intravenous (therapeutic use)
• Immunosuppressive Agents (therapeutic use)
• Intussusception (etiology, therapy)
• Male
• Methylprednisolone (therapeutic use)
• Plasma Exchange (methods)
• Retrospective Studies
• Severity of Illness Index
• Treatment Failure
• Treatment Outcome