Adrenal haematoma in Henoch–Schönlein purpura

Abstract

Sir, The expected sites of bleeding in Henoch–Schönlein purpura (HSP) are gastrointestinal and renal. We report for the first time a patient with incidental adrenal haemorrhage. An 18‐yr‐old man was hospitalized because of a recent purpuric rash involving the legs associated with abdominal pain and fever (38°C). The patient also complained of arthralgia involving the knees and the ankles. The medical history was unremarkable. Laboratory results were as follows: haemoglobin 14 g/dl, white blood cell count 7500/mm3, platelet count 323000/mm3, erythrocyte sedimentation rate 17 mm/1st h and C‐reactive protein 25 mg/dl. The prothrombin time was normal. The serum albumin level was 35 g/l and the creatinine level 0.9 mg/dl. Tests for antinuclear antibodies, cryoglobulin and rheumatoid factor gave negative results. The C3 level was 98 mg/dl (normal range 70–150) and the C4 level was 35 mg/dl (normal range 16–45). Urinalysis disclosed proteinuria (0.34 g/l) with microhaematuria. There was no blood in stool samples. The diagnosis of HSP was suspected. A biopsy of the purpuric lesion revealed leucocytoclastic vasculitis in the small vessels, with epidermal necrosis. Immunofluorescence was positive for C3. Duodenal biopsies were also performed and histological results noted: mild inflammatory lesions with mononuclear cells and neutrophils without necrosis.