Henoch Schonlein purpura in pediatric patients with inflammatory bowel disease: A case series

Area of Science:

• Pediatric Rheumatology
• Pediatric Gastroenterology
• Clinical Immunology

Background:

• Inflammatory bowel disease (IBD) encompasses chronic gastrointestinal conditions like Crohn's disease and ulcerative colitis.
• Henoch Schonlein purpura (HSP) is a systemic vasculitis characterized by purpura, arthritis, abdominal pain, and nephritis.
• The co-occurrence of IBD and HSP in pediatric patients is uncommon, necessitating further investigation into their clinical relationship.

Purpose of the Study:

• To identify the clinical characteristics of Henoch Schonlein purpura (HSP) in pediatric patients diagnosed with inflammatory bowel disease (IBD).
• To explore the potential association between anti-tumor necrosis factor (anti-TNF) therapies and the manifestation or course of HSP in children with IBD.

Main Methods:

• Retrospective chart review of pediatric patients diagnosed with both IBD and HSP.
• Analysis of clinical features, disease duration, and treatment modalities, with a specific focus on anti-TNF therapy use.

Main Results:

• Five pediatric cases of concurrent IBD and HSP were identified.
• All five patients developed HSP after their IBD diagnosis, with an average HSP duration of 20.8 months.
• Four out of five patients were undergoing anti-TNF therapy for their IBD at the time of HSP onset, suggesting a possible link.

Conclusions:

• Pediatric patients with IBD, particularly those on anti-TNF therapy, may experience chronic and recurrent episodes of Henoch Schonlein purpura.
• The findings highlight the importance of considering HSP in the differential diagnosis of children with IBD presenting with relevant symptoms.
• Further prospective studies are warranted to elucidate the pathomechanisms and optimal management strategies for HSP in the context of pediatric IBD.