Henoch-Schonlein Purpura in a Newly Diagnosed HIV Patient

  • Harshil Fichadiya Monmouth Medical Center, Long Branch, NJ, USA
  • Gaurav Mohan Monmouth Medical Center, Long Branch, NJ
  • Nimit Dalal Western Reserve Medical Education, Youngstown, OH, USA
  • Hardik Fichadiya Rutgers Trinitas Regional Medical Center, Elizabeth, NJ, USA
  • Ahmad Al-Alwan Monmouth Medical Center, Long Branch, NJ, USA
  • Raghu Tiperneni Monmouth Medical Center, Long Branch, NJ, USA
  • Farhan Khalid Monmouth Medical Center, Long Branch, NJ, USA
  • Ramon Lopez Del Valle Morsani College of Medicine, University of South Florida, FL, USA

Keywords

Human immunodeficiency virus (HIV), Henoch-Schonlein purpura (HSP), leucocytoclastic vasculitis, IgA nephropathy

Abstract

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.

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  • Published: 2022-05-04

    Issue: 2022: LATEST ONLINE (view)

    Section: Articles

    How to cite:
    1.
    Fichadiya H, Mohan G, Dalal N, Fichadiya H, Al-Alwan A, Tiperneni R, Khalid F, Lopez Del Valle R. Henoch-Schonlein Purpura in a Newly Diagnosed HIV Patient. EJCRIM 2022;2 doi:10.12890/2022_003363.

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