Henoch-Schonlein Purpura in a Newly Diagnosed HIV Patient
HIV infection is associated with multisystemic manifestations due both to secondary infections caused by a decrease in the CD4+ T-cell count and to the pathogenicity of the HIV virus itself. A common renal manifestation is HIV-associated nephropathy, which is frequently seen in the African populatio...
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| Format: | Article |
| Language: | English |
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SMC MEDIA SRL
2022-05-01
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| Series: | European Journal of Case Reports in Internal Medicine |
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| Online Access: | https://www.ejcrim.com/index.php/EJCRIM/article/view/3363 |
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| author | Harshil Fichadiya Gaurav Mohan Nimit Dalal Hardik Fichadiya Ahmad Al-Alwan Raghu Tiperneni Farhan Khalid Ramon Lopez Del Valle |
| author_facet | Harshil Fichadiya Gaurav Mohan Nimit Dalal Hardik Fichadiya Ahmad Al-Alwan Raghu Tiperneni Farhan Khalid Ramon Lopez Del Valle |
| author_sort | Harshil Fichadiya |
| collection | DOAJ |
| description | HIV infection is associated with multisystemic manifestations due both to secondary infections caused by a decrease in the CD4+ T-cell count and to the pathogenicity of the HIV virus itself. A common renal manifestation is HIV-associated nephropathy, which is frequently seen in the African population with the APOL1 gene mutation; however, other forms of glomerulopathy such as IgA nephropathy, commonly noted in other ethnicities, are also seen. Vasculitis has rarely been associated with HIV infection and mainly involves small blood vessels, although any size of blood vessel may be involved. The association of Henoch-Schonlein purpura (HSP) with HIV is rare and not well understood. We describe a 53-year-old African American woman with a newly diagnosed HIV infection who presented with a purpuric rash over the bilateral lower extremities with haematuria. Initial work-up revealed renal dysfunction with elevated ESR. Urinalysis was positive for glomerular haematuria and sub-nephrotic range proteinuria. Serum complement level, c-antineutrophil cytoplasmic antibody (ANCA), p-ANCA and anti-nuclear antibody (ANA) were negative. Renal biopsy revealed mesangial IgA deposits with crescent glomerulopathy and fibrinoid necrosis, while skin biopsy revealed leucocytoclastic vasculitis. A diagnosis of HSP was made based on American College of Rheumatology (ACR) criteria. The patient’s renal function and purpura improved with a 5-day course of steroid pulse therapy. This case of HSP in a newly diagnosed HIV patient is unusual for the presence of crescentic glomerulopathy. |
| first_indexed | 2024-04-12T11:12:17Z |
| format | Article |
| id | doaj.art-8116aae43ec0445193acff56862cb880 |
| institution | Directory Open Access Journal |
| issn | 2284-2594 |
| language | English |
| last_indexed | 2024-04-12T11:12:17Z |
| publishDate | 2022-05-01 |
| publisher | SMC MEDIA SRL |
| record_format | Article |
| series | European Journal of Case Reports in Internal Medicine |
| spelling | doaj.art-8116aae43ec0445193acff56862cb8802022-12-22T03:35:35ZengSMC MEDIA SRLEuropean Journal of Case Reports in Internal Medicine2284-25942022-05-0110.12890/2022_0033632898Henoch-Schonlein Purpura in a Newly Diagnosed HIV PatientHarshil Fichadiya0Gaurav Mohan1Nimit Dalal2Hardik Fichadiya3Ahmad Al-Alwan4Raghu Tiperneni5Farhan Khalid6Ramon Lopez Del Valle7Monmouth Medical Center, Long Branch, NJ, USAMonmouth Medical Center, Long Branch, NJWestern Reserve Medical Education, Youngstown, OH, USARutgers Trinitas Regional Medical Center, Elizabeth, NJ, USAMonmouth Medical Center, Long Branch, NJ, USAMonmouth Medical Center, Long Branch, NJ, USAMonmouth Medical Center, Long Branch, NJ, USAMorsani College of Medicine, University of South Florida, FL, USAHIV infection is associated with multisystemic manifestations due both to secondary infections caused by a decrease in the CD4+ T-cell count and to the pathogenicity of the HIV virus itself. A common renal manifestation is HIV-associated nephropathy, which is frequently seen in the African population with the APOL1 gene mutation; however, other forms of glomerulopathy such as IgA nephropathy, commonly noted in other ethnicities, are also seen. Vasculitis has rarely been associated with HIV infection and mainly involves small blood vessels, although any size of blood vessel may be involved. The association of Henoch-Schonlein purpura (HSP) with HIV is rare and not well understood. We describe a 53-year-old African American woman with a newly diagnosed HIV infection who presented with a purpuric rash over the bilateral lower extremities with haematuria. Initial work-up revealed renal dysfunction with elevated ESR. Urinalysis was positive for glomerular haematuria and sub-nephrotic range proteinuria. Serum complement level, c-antineutrophil cytoplasmic antibody (ANCA), p-ANCA and anti-nuclear antibody (ANA) were negative. Renal biopsy revealed mesangial IgA deposits with crescent glomerulopathy and fibrinoid necrosis, while skin biopsy revealed leucocytoclastic vasculitis. A diagnosis of HSP was made based on American College of Rheumatology (ACR) criteria. The patient’s renal function and purpura improved with a 5-day course of steroid pulse therapy. This case of HSP in a newly diagnosed HIV patient is unusual for the presence of crescentic glomerulopathy.https://www.ejcrim.com/index.php/EJCRIM/article/view/3363human immunodeficiency virus (hiv)henoch-schonlein purpura (hsp)leucocytoclastic vasculitisiga nephropathy |
| spellingShingle | Harshil Fichadiya Gaurav Mohan Nimit Dalal Hardik Fichadiya Ahmad Al-Alwan Raghu Tiperneni Farhan Khalid Ramon Lopez Del Valle Henoch-Schonlein Purpura in a Newly Diagnosed HIV Patient European Journal of Case Reports in Internal Medicine human immunodeficiency virus (hiv) henoch-schonlein purpura (hsp) leucocytoclastic vasculitis iga nephropathy |
| title | Henoch-Schonlein Purpura in a Newly Diagnosed HIV Patient |
| title_full | Henoch-Schonlein Purpura in a Newly Diagnosed HIV Patient |
| title_fullStr | Henoch-Schonlein Purpura in a Newly Diagnosed HIV Patient |
| title_full_unstemmed | Henoch-Schonlein Purpura in a Newly Diagnosed HIV Patient |
| title_short | Henoch-Schonlein Purpura in a Newly Diagnosed HIV Patient |
| title_sort | henoch schonlein purpura in a newly diagnosed hiv patient |
| topic | human immunodeficiency virus (hiv) henoch-schonlein purpura (hsp) leucocytoclastic vasculitis iga nephropathy |
| url | https://www.ejcrim.com/index.php/EJCRIM/article/view/3363 |
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