Bowel angina: Henoch-Schonlein purpura in adult patient based on clinical approach: a case report


  • Putu Ayu Eramitha Harnumningrat D. Departement of Internal Medicine, Wangaya Regional General Hospital, Denpasar, Bali, Indonesia
  • Ketut Suryana Departement of Internal Medicine, Wangaya Regional General Hospital, Denpasar, Bali, Indonesia



HSP in adult, Diagnosis by clinical criteria, Bowel angina, Outcome


The GI involvement of Henoch-Schonlein purpura (HSP) has often been described as self-limiting, with no long term morbidity.GI manifestation is higher in adult patient. HSP is an autoimmune disorder characterized by the deposition of IgA immune complexes in the wall of small to medium size arteries. We present a 41-year-old patient with GI involvement (Bowel angina) in HSP case admitted at Wangaya Regional Hospital Denpasar. The case are treated by steroid and symptomatic treatment. Diagnosis is established through a clinical approach with EULAR criteria. The patient recovered with supportive treatment and had a favourable clinical outcome.


Gedalia A. Henoch-Schönlein purpura. Curr Rheumatol Rep. 2004;6:195-202.

Nielsen HE. Epidemiology of Schonlein-Henoch purpura. Acta Paediatr Scand. 1988;77:125-31.

Bernhardt JP, Chatelanat F, Veyrat R. The Schonlein-Henoch syndrome in the adult. Clinical study of 16 cases, histological examination of the kidney in 7 cases. Schweiz Med Wochenschr. 1999;96:1228-9.

Debray J, Krulik M, Giorgi H: Rheumatoid purpura (Schonlein-Henoch syndrome) in the adult. Apropos of 22 cases. Sem Hop. 1971;47:1805-19.

Blanco R, Martinez-Taboada VM, Rodriguez-Valverde V, Garcia-fuentes M, Gonzalez-Gay MA. Henoch Schonlein purpura in adulthood and childhood: Two different expressions of the same syndrome. Arthritis rheum. 1997;40:859-64.

Hočevar A, Rotar Z, Jurčić V, Pižem J, Čučnik S, Vizjak A, et al. IgA vasculitis in adults: the performance of the EULAR/ PRINTO/PRES classification criteria in adults. Arthritis Res Ther. 2016;18:58.

Hong J, Yang HR. Laboratory markers indicating gastrointestinal involvement of Henoch-Schonlein purpura in children. Pediatr Gastroenterol Hepatol Nutr. 2015;18:39-47.

Hoeger PH. Prognostic parameters in Henoch-Schonlein purpura. Br J Dermatol. 2015;172:1191-2.

Yang YH, Yu HH, Chiang BL. The diagnosis and classification of Henoch–Schönlein purpura: an updated review. Autoimmunity Reviews. 2014;13:355-8.

Chen JY, Mao JH. Henoch-Schönlein purpura nephritis in children: incidence, pathogenesis and management. World J Pediatr. 2015;11:29-34.

Ozen S, Pistorio A, Iusan SM, Bakkaloglu A, Herlin T, Brik R, et al. EULAR/PRINTO/PRES criteria for Henoch-Schonlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteria. Ann Rheum Dis. 2010;69:798-806.

Landecho MF, Ros NF, Alegre F, Idoate MA, Lucena JF. HenochSchonlein purpura associated with celiac disease. J Am Acad Dermatol. 2011;64:e120-1.

Chang WL, Yang YH, Lin YT, Chiang BL. Gastrointestinal manifestations in Henoch-Schonlein purpura: a review of 261 patients. Acta Pediatr. 2004;93(11):1427-31.

Schwab J, Benya E, Lin R, Majd K. Contrast enema in children with Henoch-Schonlein purpura. J Pediatr Surg. 2005;40:1221-3.

Menon P, Singh S, Ahuja N, Winter TA. Gastrointestinal manifestations of Henoch-Schoenlein purpura. Dig Dis Sci. 2013;58:42-5.

Calvino MC, Llorca J, Garcin-Porrua C, Fernandez-Iglesias JL, Rodriguez-Ledo P, Gonzalez-Gay MA. Henoch-Schonlein purpura in children from northwestern Spain. A 20–year epidemiologic and clinical study. Medicine. 2001;80:279-90.

Sano H, Izumida M, Shimizu H, Ogawa Y. Risk factors of renal involvement and significant proteinuria in HenochSchonlein purpura. Eur J Pediatr. 2002;161(4):196-201.

Pillebout E, Thervet E, Hill G, Alberti C, Vanhille P, Nochy D. Henoch-Schonlein Purpura in adults: outcome and prognostic factors. J Am Soc Nephrol. 2002;13(5):1271-8.

Narchi H. Risk of long term renal impairment and duration of follow up recommended for Henoch-Schonlein purpura with normal or minimal urinary findings: a systematic review. Arch Dis Childhood. 2005;90(9):916-20.

Ebert EC. Gastrointestinal Manifestations of Henoch-Schonlein Purpura [Internet]. Vol. 53, Digestive Diseases and Sciences. Springer Science and Business Media LLC; 2008. p. 2011–9. Ronkainen J, Koskimies O, Ala-Houhala M, Antikainen M, Merenmies J, Rajantie J, et al. Early prednisone therapy in Henoch-Schönlein purpura: A randomized, double-blind, placebo-controlled trial [Internet]. Vol. 149, The Journal of Pediatrics. Elsevier BV; 2006. p. 241–7.

Weiss PF, Feinstein JA, Luan X, Burnham JM, Feudtner C. Effects of Corticosteroid on Henoch-Schonlein Purpura: A Systematic Review [Internet]. Vol. 120, PEDIATRICS. American Academy of Pediatrics (AAP); 2007. p. 1079–87. Available from: Han Y, Jin S-Y, Kim DW, Jeen YM, Kim YH, Choi IH. Endoscopic and microscopic findings of gastrointestinal tract in Henoch–Schönlein purpura. Medicine 2019;98:e15643.

Kang Y, Park JS, Ha YJ. Differences in clinical manifestations and outcomes between adult and child patients with Henoch-Schonlein purpura. J Korean Med Sci. 2014;29:198-203.






Case Reports