Video capsule endoscopy identifies severe small bowel lesions in a pediatric case of Henoch-Schönlein Purpura

Abstract

Figures

Video capsule endoscopy revealed multiple areas of purpuric erythema, irregular superficial ulcers, and focal areas of spontaneous bleeding in the jejunum and ileum. a–c Views from the jejunum. d View from the distal ileum.

Full text

A 12-year-old boy experienced recurrent abdominal pain for over 20 days after eating a cold hamburger. The pain, predominantly periumbilical, was accompanied by melena. Physical examination revealed periumbilical tenderness without any rash. Laboratory tests revealed an increase in WBC (23×10⁹/L), CRP (12.6 mg/L), ESR (18 mm/h), and D-dimer (2743 µg/L). Abdominal ultrasound revealed small bowel wall thickening, while the abdominal computed tomography scan showed no abnormalities. No significant lesions were found in gastroscopy and colonoscopy.

Video capsule endoscopy (VCE) was performed and revealed segmental mucosal inflammation in the jejunum and ileum, with multiple hemorrhagic spots, ecchymoses, erosions, irregular superficial ulcers, and focal areas of spontaneous bleeding ( Fig. 1 a–d , Video 1 ). Two days after the VCE, he developed hemorrhagic purpura on both lower limbs. A diagnosis of Henoch-Schönlein purpura (HSP) was made after ruling out other diseases. He was treated with methylprednisolone, resulting in significant relief of abdominal pain and resolution of melena. Follow-up abdominal ultrasound showed improvement in bowel wall thickening.

Video capsule endoscopy revealed multiple areas of purpuric erythema, irregular superficial ulcers, and focal areas of spontaneous bleeding in the jejunum and ileum. a–c Views from the jejunum. d View from the distal ileum.

Video capsule endoscopy identifies severe small bowel lesions in a pediatric case of Henoch-Schönlein purpura.Video 1

The patient additionally presented with hematuria, proteinuria, and hypertension. Renal biopsy findings were consistent with Henoch-Schönlein purpura nephritis type IIIb, and he then received mycophenolate mofetil treatment.

HSP is the most common systemic vasculitis in childhood, primarily occurring between the ages of 3 and 15 years 1 , yet diagnosing its small bowel involvement can be challenging. Reports on the use of VCE in children with HSP are rare. In 15%–35% of pediatric HSP cases, gastrointestinal symptoms precede the onset of purpura 1 2 . Studies have shown that the jejunum, ileum, and the distal part of the duodenum are the most commonly involved in gastrointestinal manifestations 3 . In this case, VCE revealed severe small intestinal lesions, whereas traditional endoscopic examinations failed to detect any abnormalities, providing a crucial clue for diagnosis.

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