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Henoch-Schönlein purpura associated with acetaminophen and codeine
D Santoro1, M Stella, S Castellino
1Unit of Nephrology and Dialysis, San Vincenzo Hospital, Taormina ASL 5, Italy. santisi@hotmail.com
Clinical Nephrology
|August 31, 2006
Summary
This case study highlights a probable link between Henoch-Schönlein Purpura (HSP) relapse and the use of paracetamol and codeine medication. Early awareness and monitoring are crucial for managing this rare adverse drug reaction.
Area of Science:
- Nephrology
- Rheumatology
- Pharmacology
Background:
- Henoch-Schönlein Purpura (HSP) is a systemic vasculitis often presenting with palpable purpura, arthritis, abdominal pain, and glomerulonephritis.
- Drug-induced HSP is uncommon, necessitating investigation into potential iatrogenic triggers.
- Paracetamol (acetaminophen) and codeine combinations are widely used for pain management.
Observation:
- A 69-year-old male experienced a relapse of HSP symptoms including fever, gross hematuria, acute renal failure, purpuric rash, arthralgias, and abdominal discomfort.
- The patient had recently commenced therapy with co-efferalgan (paracetamol and codeine) for cervical arthrosis.
- Laboratory findings indicated elevated serum creatinine and CRP, without thrombocytopenia or hypocomplementemia.
Findings:
- Discontinuation of paracetamol and codeine led to rapid resolution of gross hematuria within 2 days.
- Purpuric rash resolved in 10 days, and renal function normalized within 2 weeks.
- Naranjo algorithm assessment indicated a probable adverse drug reaction between paracetamol/codeine and HSP.
Implications:
- This case suggests a potential association between paracetamol/codeine intake and Henoch-Schönlein Purpura relapse.
- Clinicians should consider this rare adverse drug reaction in patients presenting with HSP symptoms after paracetamol/codeine use.
- Early recognition and withdrawal of the offending agent are critical for prompt patient recovery and preventing complications.
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