DIFFUSE ALVEOLAR HEMORRHAGE IN HENOCH SCHONLEIN PURPURA

Zakaria Mukalla, Yusmala Helmy* Department of Child Health, Faculty of Medicine, Sriwijaya University

Mohammad Hoesin Hospital Palembang

Abstract

Background Aside the palpable purpura, clinical manifestation of HSP could involve GIT, kidney, joints, nervous system and lung. Pulmonary involvement in HSP is very rare and most often manifests as diffuse alveolar hemorrhage (DAH), which requires agressive imunosuppressant treatment.

Objective To describe findings and management of diffuse alveolar hemorrhage in a child with Henoch-Schönlein purpura.

Case A 10 years old girl presented with hemoptysis since 6 months before. She was previously diagnosed HSP a year ago. On examination she was pale. There were purpuric rash in upper extremities and atralgia. Laboratory tests showed anemia (Hb:7,0 g/dL), WBC: 13.300/microL, ESR: 102 mm/hr, BUN: 33 mg/dL, serum creatinine: 0.4 mg/dL. Chest x-ray first presumed as active pulmonary Tb, but tuberculin test and sputum smear did not support tuberculosis. Computed tomography (CT) of the chest for confirmation demonstrated an areas of widespread ground glass appearence which is typical for difuse alveolar hemorrhage. The management were include pulse methylprednisolone and cyclophosphamide, and after 2 weeks treatment, the patient was discharge and planned to get cyclophosphamide each 3 months.

Conclusion Although it is rare, DAH should be considered if a child with HSP present hemoptysis. Current treatment using steroid and immunosuppressants result satisfying outcome.

Keywords: diffuse alveolar hemorrhage, Henoch Schonlein purpura