%0 Journal Article
%T Successful Outcome of a Corticodependent Henoch-Sch£¿nlein Purpura Adult with Rituximab
%A Taylor Pindi Sala
%A Jean-Marie Michot
%A Renaud Snanoudj
%A Marion Dollat
%A Emmanuel Est¨¨ve
%A Bernadette Marie
%A Yacine Taoufik
%A Jean-Fran£¿ois Delfraissy
%A Thierry Lazure
%A Olivier Lambotte
%J Case Reports in Medicine
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/619218
%X Henoch-Sch£¿nlein purpura (HSP) is a systemic vasculitis involving small vessels with deposition of immunoglobulin A (IgA) complexes, usually affecting children. Compared with children, HSP in adults is more severe and frequently associated with cancer. We report the case of a 49-year-old woman with medical history of kidney transplantation for segmental glomerular hyalinosis. Eight years after the transplantation, while taking combined immunosuppressive therapy with tacrolimus and azathioprine indicated for the prevention against transplant rejection, she developed a Henoch-Sch£¿nlein purpura. Vasculitis involves skin and sciatic peroneal nerve and she received systemic corticosteroid treatment. Because of four relapses and corticosteroid dependence, the patient was treated with rituximab (two intravenous infusions of 1000£¿mg given two weeks apart). Successful outcome was observed along two years of follow-up. This new case of successful use of rituximab in HSP promotes more investigations of this treatment in clinical trials. 1. Background Henoch-Sch£¿nlein purpura (HSP) is characterized by a leukocytoclastic vasculitis involving small vessels with deposition of immune IgA complexes [1]. HSP mainly affects children with an incidence around 15/100,000 per year [2] and is less frequent in adults [3]. Clinical symptoms include purpura, arthralgia, glomerulonephritis, and gastrointestinal and peripheral nerve involvement. Compared with children, clinical features and prognosis are different in adults: firstly the renal damage seems more frequent and serious, and then the frequency of associated cancers is higher [3, 4]. Cancers involved are bronchopulmonary, digestive, renal, and prostate. HSP prognosis is usually good, except in gastrointestinal and nephritis involvements. The treatment of HSP remains a matter of debate, both in adult and pediatric patients. Guidelines from pediatric experts do not support a systematic corticosteroid treatment [2, 5]. In adults the treatment usually consists in corticosteroids, eventually associated with an immunosuppressive treatment in cases of severe or relapsed forms [3, 4]. However, recent randomized studies failed to demonstrate a benefit to cyclophosphamide in addition to corticosteroids in severe glomerulonephritis forms in adults [6]. The B lymphocytes seem to be implicated in the pathogenesis of IgA nephropathy, a form of HSP limited to kidney [7, 8]. Consequently rituximab is a potential interesting targeted treatment and was already tested in three children [9] and two adult cases [10, 11] with severe HSP. We
%U http://www.hindawi.com/journals/crim/2014/619218/