Abstract
Abstract
In patients with Henoch-Schönlein purpura (HSP) presenting with severe gastro-intestinal (GI) symptoms, IgA deposition was studied in endoscopically obtained mucosal biopsies. A total number of 11 patients (male, 7; female, 4) were enrolled in this study; 7 patients underwent upper GI endoscopy and biops 1 underwent sigmoidoscopy and 3 underwent both. Upper GI endoscopy in each patient showed various mucosal changes including redness, petechiae, erosions, and ulcerations, most predominant in the second part of the duodenum. Sigmoidoscopy demonstrated no abnormality in two of four patients. Intestinal deposition of IgA was positive in 7 of 11 patients with HSP. Histological examination showed non-specific inflammation of varying degrees in each patient, but no small vessel vasculitis was observed. IgA deposits were seen in only 2 of 23 control subjects with various GI diseases. Positive rate of IgA deposition per patient was significantly higher in patients with HSP than in controls (P<0.005).
Conclusion
IgA deposition in the GI tract, as in the skin kidneys, is characteristic of HSP. Intestinal IgA deposition complements the diagnostic criferia of HSP.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- GI :
-
gastro-intestinal
- HSP :
-
Henoch-Schönlein purpura
References
Agha FP, Nostrant TT, Keren DT (1986) Leucocytoclastic vasculitis (Hypersensitivity angiitis) of the small bowel presenting with severe gastrointestinal hemorrhage. Am J Gastroenterol 81: 195–198
Andre C, Berthoux FC, Andre F, Gillon J, Genin C, Sabatier JC (1980) Prevalence of IgA2 deposits in IgA nephropathies. N Engl J Med 303: 1343–1346
Baart de la Faille-Kuyper EH, Kater L, Kooiker CJ, Dorhout Mees EJ (1973) IgA-deposits in cutaneous blood-vessel walls and mesangium in Henoch-Schönlein syndrome. Lancet I: 892–893
Bannister KM, Drew PA, Clarkson AR, Woodroffe AJ (1983) Immunoregulation in glomerulonephritis, Henoch-Schönlein purpura and lupus nephritis. Clin Exp Immunol 53: 384–390
Beale MG, Nash GS, Bertovich MJ, MacDermott RP (1983) Evidence of enhanced immunoglobulin synthesis and defective immune regulation in Henoch-Schönlein purpura. Contrib Nephrol 35: 46–60
Casanueva B, Rondriguez-Valverde V, Merino J, Arias M, Garcia-Fuentes M (1983) Increased IgA-producing cells in the blood of patients with active Henoch-Schönlein purpura. Arthritis Rheum 26: 854–860
Conley ME, Cooper MD, Michael AF (1980) Selective deposition of immunoglobulin Al in immunoglobulin A nephropathy, anaphylactoid purpura nephritis, and systemic lupus erythematosus. J Clin Invest 66: 1432–1436
Coppo R, Basolo B, Piccoli G, Mazzucco G, Bulzomi MR, Roccatello D, De Marchi M, Carbonara AO, Barbiano Di, Belgiojono G (1984) IgA1 and IgA2 immune complexes in primary IgA nephropathy and Henoch-Schönlein nephritis. Clin Exp Immunol 57: 583–590
Giangiacomo J, Tsai CC (1977) Dermal and glomerular deposition of IgA in anaphylactoid purpura. Am J Dis Child 131: 981–983
Glasier CM, Siegel MJ, McAlister WH, Shackelford GD (1981) Henoch-Schönlein syndrome in children: gastrointestinal manifestations. Am J Roentgenol 136: 1081–1085
Götze O, Muller-Eberhard HJ (1971) The C3 activation system: an alternate pathway of complement activation. J Exp Med 134 [Suppl]: 90–108
Hiemstra PS, Gorter A, Stuurman ME, Van Es LA, Daha MR (1987) Activation of the alternative pathway of complement by human serum IgA. Eur J Immunol 17: 321–326
Imai H, Chen A, Wyatt RJ, Rifai A (1988) Lack of complement activation by human IgA immune complexes. Clin Exp Immunol 73: 479–483
Kato S, Nakagawa H, Harada Y, Saito Y, Watanabe N, Abe J, Yamamoto K, Shibuya H, Takahashi K, Watanabe S (1991) A clinical study of upper gastrointestinal endoscopy in Japanese children. Acta Paediatr Jpn 33: 36–42
Kato S, Shibuya H, Naganuma H, Nakagawa H (1992) Gastrointestinal endoscopy in Henoch-Schönlein purpura. Eur J Pediatr 151: 482–484
Klauffmann RH, Herrmann WA, Meÿer CJLM, Daha MR, Van Es LA (1980) Circulating IgA-immune complexes in Henoch-Schönlein purpural. Am J Med 69: 859–866
Knight JF (1990) The rheumatic poison: a survey of some published investigations of the immunopathogenesis of Henoch-Schönlein purpura. Pediatr Nephrol 4: 533–541
Kuno-Sakai H, Sakai H, Nomoto Y, Takakura I, Kimura M (1979) Increased of IgA-bearing peripheral blood lymphocytes in children with Henoch-Schoenlein purpura. 64: 918–922
Morichau-Beauchant M, Touchard G, Maire P, Briaud M, Babin P, Alcalay D, Maruchansky C (1982) Jejunal IgA and C3 deposition in adult Henoch-Schönlein purpura with severe intestinal manifestations. Gastroenterology 82: 1438–1442
Osawa Y, Suzuki S, Itoh M, Igarashi K, Shima H, Chiba M, Nagasaki A, Arakawa H, Masamune O (1986) A case of adult Schoenlein-Henoch purpura accompanied by multiple erosions and ulcers in the gastrointestinal tract. Gastroenterol Endosc 28: 1289–1294
Stevenson JA, Leong LA, Cohen AH, Border WA (1982) Henoch-Schönlein purpura. Arch Pathol Lab Med 106: 192–195
Trygstad CW, Stiehm ER (1971) Elevated serum IgA globulin in anaphylactoid purpura. Pediatrics 47: 1023–1028
Tsai CC, Giangiacomo J, Zuckner J (1975) Dermal IgA deposition in Henoch-Schönlein purpura and Berger's nephritis. Lancet I: 342–343
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kato, S., Ebina, K., Naganuma, H. et al. Intestinal IgA deposition in Henoch-schönlein purpura with severe gastro-intestinal manifestations. Eur J Pediatr 155, 91–95 (1996). https://doi.org/10.1007/BF02075757
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02075757