Henoch-Schonlein purpura in mesothelioma

Our plain-English summary of Henoch-Schonlein purpura in mesothelioma, by S. Joshi, S. Pillai, A. Chakera, et al (Respirology Case Reports, 2014).

The study

• Authors: S. Joshi, S. Pillai, A. Chakera, Y.C. Lee
• Journal: Respirology Case Reports
• Published: 2014;2(4):138-40
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Henoch-Schonlein purpura (HSP) is primarily a childhood immunoglobulin A (IgA)-mediated illness. When adults are affected, malignancy can be associated. We present a rare case of HSP in a 75-year-old man with malignant pleural mesothelioma. He presented with episodes of dizziness and subsequently developed non-palpable purpura across his legs, arthralgia, hematuria, proteinuria, and acute renal impairment. HSP was diagnosed based on clinical and histological findings on biopsy specimens from the skin and kidney that showed a leukocytoclastic vasculitis and mesangioproliferative glomerulonephritis with IgA deposits, respectively. He was treated with high-dose oral steroids with resolution of the skin and renal manifestations of the disease. HSP is rare in adults but has been linked to cancers. This is the first report of HSP in a patient with known malignant pleural mesothelioma.

In plain English

This article is a case report from Perth, Western Australia, about one patient: a 75-year-old man with right-sided malignant pleural mesothelioma. It had been diagnosed 10 months earlier and never treated with chemotherapy or radiation. He had been an architect with significant occupational asbestos exposure; the article does not name a fiber type. He came to hospital with dizziness, a flat pinpoint rash on both legs, and new kidney impairment, with protein and blood in his urine. Skin and kidney biopsies showed inflamed small blood vessels and kidney deposits of the antibody IgA. Doctors diagnosed Henoch-Schonlein purpura (HSP), an immune condition seen mostly in children. His kidney problems did not improve after 3 weeks of conservative care, so he was given the oral steroid prednisolone. His kidney impairment resolved over 8 weeks. He died 5 months after presenting, from progression of mesothelioma, without HSP returning. The authors described this as the first case of HSP developing during the course of pleural mesothelioma. A single case shows what happened to one person, not how often this occurs.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 75-year-old Caucasian man in Perth, Western Australia, with right-sided malignant pleural mesothelioma diagnosed 10 months before presentation and never treated with chemo-irradiation; a non-smoker
• Exposure: Significant occupational asbestos exposure as an architect; no fiber type, products or dose given
• Main results:
  • The patient had new kidney impairment: creatinine 124 μmol/L, compared with 84 μmol/L two weeks earlier
  • The patient had protein in his urine (protein-creatinine ratio of 474 mg/mmol)
  • The skin biopsy showed inflammation around blood vessels with leukocytoclastic debris
  • The kidney biopsy showed mesangio-proliferative glomerulonephritis, and a clinical diagnosis of HSP was made
  • HSP developed 10 months after the mesothelioma was diagnosed
  • The rash subsided, but kidney impairment and inflammation did not improve after 3 weeks of conservative therapy
  • Oral prednisolone (1 mg/kg/day) was started and gradually reduced over 4 months
  • Kidney impairment resolved over 8 weeks, and urine tests at 3 months showed no protein or blood
  • The patient died 5 months after first presenting, from progression of mesothelioma, without HSP or kidney impairment returning
• The authors' conclusion: The authors reported this as the first case of HSP developing during the course of malignant pleural mesothelioma. They concluded that corticosteroid therapy was followed by clinical and biochemical benefit in this patient.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleural Mesothelioma, Biopsy.

Related studies

• Recurrent thrombotic thrombocytopenic purpura-like syndrome as a paraneoplastic phenomenon in malignant peritoneal mesothelioma: a case report and review of the literature — F. Socola, A. Loaiza-Bonilla, et al. (2012)
• A case of primary lung squamous cell carcinoma mimicking malignant mesothelioma producing granulocyte colony stimulating factor with chemotherapy (cisplatin and gemcitabine)-associated thrombotic thrombocytopenic purpura (TTP); An autopsy case report — Y. Suzuki, K. Kanazawa, et al. (2019)
• Comparison of fibulin-3 and mesothelin as markers in malignant mesothelioma — J. Creaney, I.M. Dick, et al. (2014)
• Outcome of patients with nonspecific pleuritis/fibrosis on thoracoscopic pleural biopsies — H.E. Davies, J.E. Nicholson, et al. (2010)
• Complications of indwelling pleural catheter use and their management — M.M. Lui, R. Thomas, et al. (2016)
• The diagnosis of pleural effusions — J.M. Porcel, M. Azzopardi, et al. (2015)

Browse more research in Respirology Case Reports, or return to medical research.