Brief Report

Pediatric Nephrology

, Volume 15, Issue 3, pp 276-278

First online:

Cerebral vasculitis in Henoch-Schönlein purpura: a case report with sequential magnetic resonance imaging changes and treated with plasmapheresis alone

  • Chien-Liang ChenAffiliated withDivision of Nephrology, Department of Internal Medicine, Veterans General Hospital, Kaohsiung, Taiwan 813, Republic of China
  • , Y.-H. ChiouAffiliated withDivision of Nephrology, Department of Pediatrics, Veterans General Hospital, 386, Ta-Chung First Road, Kaohsiung, Taiwan 813, Republic of China e-mail: cclchen@isca.vghks.gov.tw or cclchen@pavo.seed.net.tw Tel.: +886-7-34222121, ext. 2044, Fax: +886-6-2004767
  • , Chan-Yao WuAffiliated withDivision of Nephrology, Department of Pediatrics, Veterans General Hospital, 386, Ta-Chung First Road, Kaohsiung, Taiwan 813, Republic of China e-mail: cclchen@isca.vghks.gov.tw or cclchen@pavo.seed.net.tw Tel.: +886-7-34222121, ext. 2044, Fax: +886-6-2004767
  • , Ping-Hong LaiAffiliated withDepartment of Diagnostic Radiology, Veterans General Hospital, Kaohsiung, Taiwan 813, Republic of China
  • , Hsiao-Min ChungAffiliated withDivision of Nephrology, Department of Internal Medicine, Veterans General Hospital, Kaohsiung, Taiwan 813, Republic of China

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Abstract 

Neurological complications are rare during the course of Henoch-Schönlein purpura (HSP). We report a 7-year-old girl with HSP who presented with seizures, loss of vision and disturbance of consciousness. Magnetic resonance imaging (MRI) showed high signal intensity in the gray and white matter over the left parietal and both occipital lobes, compatible with MRI findings of cerebral vasculitis. The eye fundi revealed multiple branches of retinal artery occlusion. Intravenous pulse methylprednisolone (MTP) followed by oral steroid therapy was initially administered for HSP nephritis. Cerebral vasculitis developed 10 days post-MTP treatment, with progressive worsening of consciousness. Oral steroid was discontinued and plasmapheresis was performed alone. Her level of consciousness dramatically improved after plasmapheresis. The brain MRI and eye fundi findings were consistent with her clinical improvement. To the best of our knowledge, this is the first description of MRI abnormalities and multiple retinal artery branch occlusion of cerebral vasculitis in a patient with HSP that was successfully treated by plasmapheresis alone. In conclusion, we propose that plasmapheresis may be used as a first-line therapy or rescue therapy for cerebral vasculitis in HSP.

Key words Henoch-Schönlein purpura Methylprednisolone Magnetic resonance imaging