HEMORRHAGIC VASCULITIS (HENOCH-SCHONLEIN PURPURA) IN PREGNANCY: LITERATURE REVIEW AND CASE REPORT

Keywords: hemorrhagic vasculitis, Henoch-Schonlein purpura, pregnancy

Abstract

Aim. The paper aims at reviewing publications and analyzing a clinical case of Henoch-Schonlein purpura in a pregnant patient. This pathology is extremely rare in pregnancy (solely about 20 cases reported in the available literature)

Materials and Methods. A systematic literature search was performed in Pubmed and other sources on peculiarities of gestation in Henoch-Schonlein purpura. A case of Henoch-Schonlein purpura in a pregnant woman, who delivered in 2020 in Lviv Maternity Hospital №1 is presented.

Results and Discussion. Henoch-Shonlein purpura is extremely rare disease in pregnant women. Only about 20 cases are presented in all available literature. Pregnancy course in described cases was usually favorable. Most patients were delivered by cesarean section for different reasons. About 25% of presented cases were complicated by nephrotic syndrome and superposition of preeclampsia, requiring preterm delivery. No case of placental vasculitis was detected at histological examination of placentas. Our case report: 33-years old patient, primigravida. Henoch-Schonlein purpura diagnosed 8 years ago. The course of the disease was chronic recurrent with predominant skin and joints lesions. Nephrotic syndrome was observed 4 years before pregnancy for last time. The patient continuously received corticosteroid therapy. Course of pregnancy was complicated by mild preeclampsia in the third trimester. A healthy girl weighting 3200g was delivered physiologically at term. No complications were observed in the postpartum period.

Conclusions. Hemorrhagic vasculitis (Henoch-Shonlein purpura) is an extremely rare disease in pregnancy. In absence of nephrotic syndrome, the course of pregnancy and delivery is favorable, but these patients require\h thorough monitoring for early detection of nephrotic syndrome and/or preeclampsia manifestations.

References

Abu-Zaid MH, El Miedany Y, Hassan W, et al. Updates on the evidence based interdisciplinary guidelines for Henoch-Schonlein purpura. Presented at: European League Against Rheumatism (EULAR) Congress 2019; June 12-15, 2019; Madrid, Spain. Abstract AB0922.

Boyarchuk O.R, Sahal' I.R.: Hemorahichnyy (IgA-) vaskulit u ditey: suchasnyy pohlyad na problemu / Klinichna immunolohiya. Alerholohiya. Infektolohiya. 2017; 7-8(104-105):.25-29 Ukrainian (Боярчук О.Р., Сагаль І.Р. Геморагічний (IgA-) васкуліт у дітей: сучасний погляд на проблему / Клінічна іммунологія. Алергологія. Інфектологія. 2017;7-8(104-105):25-29.

Chakrabarti SB, Tigga MP, Ray J., Debbarma A.: Int J Reprod Contracept Obstet Gynecol. 2015;4(4):1227-1230.

Cummins DL, Mimouni D, Rencic A, Kouba DJ, Nousari CH. Henoch-Schonlein purpura in pregnancy. Br J Dermatol. 2003;149:1282-5.

Djakovic I, Butorac D, Vucicevic Z, Kosec V, Kuna AT, Lugovic-Mihic L: Henoch-Schonlein purpura in the third trimester of pregnancy Biochem Med (Zagreb). 2018; 28(1): 010801.

Ekoukou D, Karaoui B, Bazin C.: Rheumatoid purpura (or Schoenlein-Henoch syndrome) and pregnancy. Review of the literature and a case report. J Gynecol Obstet Biol Reprod. 1997;26(2):197-201.

Feldmann R, Rieger W, Sator PG, Gschnait F, Breier F.: Schonlein-Henoch purpura during pregnancy with successful outcome for mother and newborn. BMC Dermatol. 2002;2:1.

Forbes T., Lunn A., Langstaff C. Guideline for Management of Henoch-Schonlein Purpura and Henoch-Schonlein Purpura Nephritis // Nottingham Children's Hospital, 2016. - 17 p.

Hetland LE, Susrud KS, Lindahl KH, Bygum A: Henoch-Schonlein Purpura: A Literature Review Acta Derm Venereol. 2017 Nov 15;97(10):1160-1166. doi: 10.2340/00015555-2733

Joseph G, Holtman JS, Kosfeld RE, Blodgett WA, Liu YK.: Pregnancy in Henoch-Schonlein purpura.Am J Obstet Gynecol. 1987;157:911-2.

Kalmantis K, Daskalakis G, Iavazzo C, Vranos A, Mesogitis S, Antsaklis A. Henoch-Schonlein purpura in pregnancy. J Obstet Gynaecol. 2008;28:403-5.

Koizumi M, Hagino D, Fukuyama C, Abe K, Inoue K, Arai Y, Takechi K: Schonlein-Henoch purpura during pregnancy: Case report and review of the literature. J Obstet Gynaecol Res. 2004;30:37-41.

Le Goff C, Chatelier C, Lobbedez T,Henri P, Levaltier B, Ryckelynck JP, Hurault de Ligny B: Rheumatoid purpura during pregnancy Nephrologie 1997;18(1):27-9.

McCoy MJ: Henoch-Schonlein purpura and pregnancy. Am J Obstet Gynecol 1981; 141: 469-470

Merill J, Lahita RG.: Henoch-Schonlein purpura remitting in pregnancy and during sex steroid therapy. Br J Rheumatol. 1994;33:586-8.

Mills J.A., Michel B.A., Bloch D.A., et al. The American College of Rheumatology 1990 criteria for the classification of Henoch-Schonlein purpura // Arthritis and Rheumatism. 1990; 33 (8):1114-21.

Miyata M, Kumakawa H, Funabashi Y, Suenaga K, Hanzawa S, Takahashi M, Ogata M, Kasukawa R: Henoch-Schonlein purpura associated with pregnancy in a patient with chronic thyroiditis. Fukushima J Med Sci. 1994;40(1):45-9.

Muszytowski M, Ruszkiewicz-Fo?da M.: A case of acute renal failure in pregnancy complicated by Henoch-Schoenlein purpura requiring hemodialysis therapy. Ginekol Pol. 1996;67(1):42-4.

Nakaz MOZ Ukrayiny №676 vid 12.10.2006 "Pro zatverdzhennya protokoliv nadannya medychnoyi dopomohy za spetsialnistyu "Revmatolohiya" Ukrainian (Наказ МОЗ України №676 від 12.10.2006 "Про затвердження протоколів надання медичної допомоги за спеціальністю "Ревматологія").

Nguyen Tan Lung R, Granier M, Gaudry C, Kourilsky O: Cyclophosphamide during pregnancy: a safe prescription. J Gynecol Obstet Biol Reprod. 1995; 24(3): 314-8.

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.

Plauche WC: Henoch-Schonlein (anaphylactoid) nephropathy in pregnancy. Obstet Gynecol 1980; 56: 515-517.

Praveen T, Begum F.: Henoch Schonlein Purpura, a rare disease in pregnancy. Bangladesh J Obstet Gynecol. 2008;23(2):73-7.

Ray M, Posen GA.: Henoch Schonlein purpura in pregnancy. Can Med Asso J. 1985;132(12):1385-6.

Tayabali S, Andersen K, Yoong W. Diagnosis and management of Henoch-Schonlein purpura in pregnancy: a review of the literature. Arch Gynecol Obstet. 2012;286:825-9.

Wilks RL, Abdella TN, Alfano CA: Henoch-Schonlein purpura associated with eclampsia. A case report. J Reprod Med. 1993 Aug;38(8):645-6.

Yasukawa K, Kohno M, Ohmoto A, Matsuyama R: Henoch-Schonlein nephritis with nephrotic syndrome during pregnancy. Nihon Rinsho Meneki Gakkai Kaishi. 1996;19(5):505-11.

Published
2021-12-23
How to Cite
Markin, L., & Rachkevych, O. (2021). HEMORRHAGIC VASCULITIS (HENOCH-SCHONLEIN PURPURA) IN PREGNANCY: LITERATURE REVIEW AND CASE REPORT. Acta Medica Leopoliensia, 27(3-4), 52-58. https://doi.org/10.25040/aml2021.3-4.052