Intra-Alveolar Haemorrhage Complicating IgA Vasculitis: A Case Report, Literature Review and Discussion of Treatment

  • Benjamin Savoye Department of Internal Medicine and Clinical Immunology, CHU de Caen Côte de Nacre, Caen, France
  • Gwenola Maigne Department of Internal Medicine and Clinical Immunology, CHU de Caen Côte de Nacre, Caen, France
  • Evangeline Pillebout Department of Nephrology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
  • Gaetane Planchard Department of Pathology, CHU de Caen Côte de Nacre, Caen, France
  • Maxime Faisant Department of Pathology, CHU de Caen Côte de Nacre, Caen, France
  • Achille Aouba Department of Internal Medicine and Clinical Immunology, CHU de Caen Côte de Nacre, Caen, France
  • Alexandra Audemard Department of Internal Medicine and Clinical Immunology, CHU de Caen Côte de Nacre, Caen, France

Keywords

IgA vasculitis, Henoch-Schönlein purpura, intra-alveolar haemorrhage, cancer

Abstract

Introduction: Immunoglobulin A vasculitis (IgAV) is a small-vessel vasculitis with IgA-dominant immune deposits. IgAV frequently involves the skin, gastrointestinal tract, joints and kidneys. In contrast to other types of small-vessel vasculitis, IgAV is rarely complicated by intra-alveolar haemorrhage (IAH).
Methods/Results: We describe a patient with relapsing bladder cancer who presented with IAH during the course of IgAV successfully treated with corticosteroids alone.
Conclusion: This case report reminds us that IgAV can manifest with IAH. There are no robust data to support the systematic use of cyclophosphamide or plasma exchange as first-line therapy for IgAV with IAH.

References

  • Audemard-Verger A, Terrier B, Dechartres A, et al. Characteristics and management of IgA vasculitis (Henoch-Schonlein) in adults: data from 260 patients included in a French multicenter retrospective survey. Arthritis Rheumatol 2017;69:1862–1870.

  • Rajagopala S, Shobha V, Devaraj U, D'Souza G, Garg I. Pulmonary hemorrhage in Henoch-Schonlein purpura: case report and systematic review of the English literature. Semin Arthritis Rheum 2013;42:391–400.

  • Pillebout E, Alberti C, Guillevin L, Ouslimani A, Thervet E. Addition of cyclophosphamide to steroids provides no benefit compared with steroids alone in treating adult patients with severe Henoch Schonlein purpura. Kidney Int 2010;78:495–502.

  • Walsh M, Merkel P, Jayne D. The effects of plasma exchange and reduced-dose glucocorticoids during remission-induction for treatment of severe ANCA-associated vasculitis. Presented at the 2018 ACR/ARPH Annual Meeting. ACR Meeting Abstracts. Available from https://acrabstracts.org/abstract/the-effects-of-plasma-exchange-and-reduced-dose-glucocorticoids-during-remission-induction-for-treatment-of-severe-anca-associated-vasculitis/ (accessed 9 Nov 2018).
  • Published: 2019-03-25

    Issue: Vol 6 No 4 (view)

    Section: Articles

    How to cite:
    Savoye, B., Maigne, G., Pillebout, E., Planchard, G., Faisant, M., Aouba, A., & Audemard, A. (2019). Intra-Alveolar Haemorrhage Complicating IgA Vasculitis: A Case Report, Literature Review and Discussion of Treatment. European Journal of Case Reports in Internal Medicine, 6(4). https://doi.org/https://doi.org/10.12890/2019_001083