Gastrointestinal Biopsy in Henoch-Schönlein Purpura: A Great Diagnostic Contribution

Henoch-Schönlein purpura is an IgA-mediated immune vasculitis which is characterized by purpuric lesions and osteoarticular, intestinal and sometimes renal manifestations. The histopathological substrate of this entity is leucocytoclastic vasculitis (LCV) with IgA deposits seen on immunohistochemistry. We here report the case of a 27-year-old woman with abdominal pain and cutaneous purpura. Upper and lower endoscopic exploration showed purpuric lesions in the rectum but not in the stomach. Skin biopsy revealed LCV. IgA deposits were seen only in gastric mucosa. The patient was treated with corticoids which led to improvement of both the cutaneous and digestive symptoms. This case suggests that gastrointestinal biopsies of both normal and abnormal mucosa should be taken in Henoch-Schönlein purpura, especially in patients with atypical forms.

The diagnosis of Henoch-Schönlein purpura may be difficult, especially in patients with atypical forms.Identification of IgA deposits is important for the diagnosis; these deposits may be absent in skin biopsies but present in gastrointestinal mucosa despite the absence of lesions on endoscopy.Therefore, taking gastrointestinal biopsies of both involved and uninvolved mucosa is important.