Henoch–Schönlein purpura (HSP) is a systemic disease
characterized by the deposition of immune complexes and involving multiple
organs [1]. One of the organs commonly affected is the
gastrointestinal tract. Since approximately 15 % of patients with
HSP develop purpura after the appearance of digestive symptoms
[2], early diagnosis by detection of gastrointestinal
lesions using endoscopy and immediate treatment are necessary. Here, we report
two cases of HSP examined by chromoendoscopy with indigo carmine contrast. This
procedure clearly delineates the endoscopic features of active ileac lesions of
HSP, and has also been proven as useful for treatment assessment.
Case 1
A 32-year-old man attended the hospital for lower abdominal pain and
diarrhea, accompanied by purpura of the shanks. Urgent total colonoscopy
revealed severe diffuse redness in the terminal ileum, along with shallow,
insular ulcers with a fur coating ([Fig. 1 a]). The chromoendoscopic view with
indigo carmine contrast demonstrated redness in each intestinal villus, thought
to be equivalent to the so-called “hemorrhagic bleb” ([Fig. 1 b]), a typical endoscopic feature of an
active intestinal lesion in HSP [3]. On the other hand,
the contrast view clearly delineated the margin between the inflamed villi and
the ulcerations ([Fig. 1 c]).
Fig. 1 Case 1.
a Total colonoscopy showing severe diffuse redness and
insular, fur-coated, shallow ulcers in the terminal ileum. b Chromoendoscopic view with indigo carmine contrast
demonstrates redness of the intestinal villi (similar to the so-called
“hemorrhagic blebs”). c The boundary between
the inflamed villi and the ulcerations is clearly visualized on the contrast
view.
Case 2
A 27-year-old man attended the hospital for lower abdominal pain.
Total colonoscopy showed widespread redness, consisting of granular
“hemorrhagic blebs”, discrete ulcers, and severe mucosal edema in
the terminal ileum ([Fig. 2 a]). Because of
the severe inflammation, the villi in the ileac mucosal layer seemed to be
atrophied or sloughed off. Colonoscopy was performed 14 days after prednisolone
administration, and the redness, ulcers, and edema were found to have nearly
disappeared (as observed in the conventional view, [Fig. 2 b]). The chromoendoscopic view with
indigo carmine contrast clearly demonstrated not only the disappearance of
redness but also the regeneration of the villous structure ([Fig. 2 c]).
Fig. 2 Case 2.
a Total colonoscopy view: there is extensive redness of
the terminal ileum, consisting of granular “hemorrhagic blebs”,
discrete ulcers, and severe mucosal edema. The villous structure of the ileac
mucosa appears to be atrophied or sloughed off. b
Conventional colonoscopy following treatment with prednisolone. Note the
absence of redness, ulcers, and edema. c Chromoendoscopy
following treatment with prednisolone. This view clearly shows the
disappearance of redness as well as the regeneration of the mucosal villi.
Endoscopy_UCTN_Code_CCL_1AD_2AF
