A different approach in a case of recurrent purpura

CASE REPORTS

A Different Approach in a Case of Recurrent Purpura

Joana Filipe Ribeiro¹, João Virtuoso¹, Ana Pinto², Rita S. Oliveira¹, Joana Ferreira², Manuel Salgado³.

¹Serviço de Pediatria, Hospital Sousa Martins, ULS Guarda, Guarda, Portugal,
²Serviço de Reumatologia, Hospital Sousa Martins, ULS Guarda, Guarda, Portugal,
³Unidade de Reumatologia Pediátrica, Hospital Pediátrico de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.

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Abstract
Henoch-Schönlein Purpura (HSP) is an acute, systemic, immune complex-mediated leukocytoclastic vasculitis and the most common vasculitis of childhood. HSP is typically self-limited, although some patients experience one or more recurrences. We presented a 16-year-old male, with palpable purpura, abdominal pain and arthralgia, who was diagnosed with HSP. Due to intense and persisting abdominal pain, a high-dose oral prednisolone was initiated, resulting in clinical improvement. However, every attempt at weans off of prednisolone resulted in disease relapse. Combination therapy with colchicine allowed the discontinuation of corticosteroid therapy and no relapses of the disease was observed. The management of HSP cases with an unusual and complicated presentation remains controversial. However, several cases of successful treatment using immunomodulatory therapy have been reported. The use of colchicine has enabled the successful tapering off prednisolone, reduced its side effects and prevented further recurrences.

Why this article important?

By introducing colchicine in the therapeutic approach of recurrent Henoch-Schonlein Purpura (HSP), we successfully achieved the tapering of prednisolone, minimizing its side effects and effectively preventing further recurrences. The potential efficacy of colchicine, coupled with its favorable safety profile, warrants its consideration as a therapeutic choice for severe and chronic PHS in childhood. We believe that our case report offers valuable insight and adds to the current literature reports about the management of recurrent HSP, which can prove beneficial to clinicians in the treatment of their own patients. Besides this, our manuscript highlights the need for more data and investigation about recurrent HSP, its potential therapeutic options and outcomes.

Summary of article

Henoch-Schönlein purpura is the most common childhood vasculitis and it is typically a benign and self-limiting condition. However, approximately 30% of cases may experience recurrence or progress to chronic disease, leading to ongoing management challenges. In this report, we present a case of Henoch-Schönlein purpura that exhibited relapses during the tapering of corticosteroids. Considering the potential of immunomodulatory therapy, such as colchicine, in managing relapsing disease, we incorporated colchicine into the treatment regimen. Over a 12-month follow-up period, the patient showed favorable clinical evolution with no new recurrences episodes, and it was possible to discontinue both corticosteroid therapy and colchicine.

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