DDSEP® 8 Quick Quiz

Question 2

Publish date: March 31, 2021

Q2. A 26-year-old White male presented with fever and sore throat for 5 days along with erythematous, nonpruritic rash involving the extremities and arthralgias. He subsequently developed right lower-quadrant pain, aggravated with meals, and associated with watery diarrhea. Labs show showed white blood cell count of 14,900/microL and a C-reactive protein level of 12.6 mg/dL. A magnetic resonance enterography showed 20 cm of thickened ileum. An upper endoscopy showed multiple erosions in the duodenum and antrum while a colonoscopy showed erythema and inflammation in the terminal ileum and cecum. Biopsies from both areas demonstrated evidence of leukocytoclastic vasculitis. Skin biopsy also showed leukocytoclastic vasculitis.

Which of the following agents would you recommend next?

Sulfasalazine

Prednisone

Azathioprine

Infliximab

Vedolizumab

Correct answer: B. Prednisone


Rationale
This is a case of Henoch-Schönlein purpura, which is a self-limited, systemic, nongranulomatous, autoimmune complex, small-vessel vasculitis with multiorgan involvement. It is characterized by a classic tetrad of nonthrombocytopenic palpable purpura, arthritis or arthralgias, gastrointestinal involvement, and renal involvement. GI involvement may mimic Crohn's disease, although the biopsies are usually diagnostic. Most cases are self-limiting, but oral steroids are indicated in patients with severe colicky abdominal pain; usually they're started as prednisone or methylprednisolone at 1-2 mg/kg per day for 1-2 weeks and then tapering to a stop in the next 1-2 weeks. Steroids may prevent major complications such as gastrointestinal bleeding or intussusception. Immunosuppressive drugs (cyclophosphamide, azathioprine, cyclosporine A, and mycophenolate mofetil) in combination with high-dose IV pulse steroids are recommended if there is no benefit from steroids alone.

Reference
Sohagia AB et al. Gastroenterol Res Pract. 2010. doi: 10.1155/2010/59764.

Next Article:

Top cases