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Management of intestinal bleeding with single-dose cyclophosphamide in Henoch-Schönlein purpura

Ünal Uluca1, Aydın Ece2, Velat Şen1

  • 1Departments of Pediatrics.

Pediatrics International : Official Journal of the Japan Pediatric Society
|June 27, 2015
PubMed

Insights

Cyclophosphamide (CPA) effectively treated severe gastrointestinal bleeding in Henoch-Schönlein purpura (HSP) cases unresponsive to steroids. This single-dose CPA therapy prevented further bleeding and surgical intervention in pediatric patients.

Area of Science:

  • Pediatric Nephrology
  • Pediatric Gastroenterology
  • Pediatric Rheumatology

Background:

  • Henoch-Schönlein purpura (HSP) is a common childhood vasculitis.
  • Gastrointestinal (GI) involvement, particularly severe bleeding, can complicate HSP management.
  • High-dose corticosteroids are a standard treatment, but resistance can occur.

Observation:

  • This case series details six children (aged 5-13) with severe GI bleeding due to HSP.
  • Patients exhibited resistance to standard intravenous methylprednisolone therapy.
  • Bleeding persisted despite both conventional and pulse steroid regimens.

Findings:

  • A single intravenous dose of cyclophosphamide (CPA) at 500 mg/m(2) was administered.
  • All six patients achieved complete resolution of GI bleeding post-CPA treatment.
  • No patient required surgical intervention, and no new bleeding events were reported after CPA.

Implications:

  • Single-dose cyclophosphamide may represent a novel therapeutic option for steroid-resistant severe GI bleeding in HSP.
  • This approach could potentially avoid surgical interventions in severe pediatric HSP cases.
  • Further research is warranted to confirm the efficacy and safety of CPA in this specific HSP complication.

Keywords:
Henoch-Schönlein purpuracyclophosphamidegastrointestinal bleedingsteroidtreatment

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