Dear Editor,
We read with interest an article on ˇ°Use of Wireless Capsule Endoscopy in
the Management of Severe Henoch-Schonlein Purpuraˇ± by Preud'homme et al.
[1]. They reported a 12-year-old boy with chronic HSP vasculitis, which
primarily affects the gastrointestinal tract, showing protracted course,
multiple recurrences of hematochezia or melena, and steroid dependency. In
this case, wireless capsule endoscopy (WCE) was helpful in evaluating and
directing treatment options, such as intensive immunosuppression
(cyclophosphamide and MMF).
WCE can be used to evaluate morphologically the extent of gastrointestinal
vasculitic processs, but it may not give us the information about the
severity of gastrointestinal symptoms. There have been some reports
describing that severe gastrointestinal symptoms are closely associated
with decreased factor XIII levels in both children and adults with HSP [2,
3]. Fukui et al reported that decrease in factor XIII level was correlated
with the severity score of clinical symptoms, particularly abdominal
symptoms in fifty-six children with HSP, and severe abdominal symptoms
were improved remarkably in accordance with the increase of factor XIII
level after the administration of factor XIII concentrate compared with
non-treated group [2]. Also, Shimomura et al. recently reported an adult
patient with HSP who had arthralgia, severe abdominal pain, and low plasma
factor XIII activity [3]. In this case, severe abdominal pain was markedly
improved immediately after the administration of factor XIII concentrate,
suggesting factor XIII activity might play an important role in the
pathogenesis of abdominal vasculitic process associated with HSP.
Therefore, it would be helpful to measure factor XIII activity rather
than WCE when we assess the severity of mesenteric vasculitis in patients
with HSP, and factor XIII concentrate could be useful for alleviating
severe abdominal symptoms before considering intensive immunosuppression
in HSP patients.
References
1. Preud'homme DL, Michail S, Hodges C, Milliken T, Mezoff AG. Use of
Wireless Capsule Endoscopy in the Management of Severe Henoch-Schonlein
Purpura. Pediatrics 2006 Jul 31; [Epub ahead of print]
2. Fukui H, Kamitsuji H, Nagao T, et al. Clinical evaluation of a
pasteurized factor XIII concentrate administration in Henoch-Schonlein
purpura. Japanese Pediatric Group. Thromb Res 1989;56:667-75.
3. Shimomura N, Kawai K, Watanabe S, et al. Adult Henoch-Schonlein purpura
with severe abdominal pain treated with dapsone and factor XIII
concentrate. J Dermatol 2005;32:124-7.
Conflict of Interest:
None declared
eLetters: ![[Read eLetters]](/icons/misc/sectionDOWN.gif){kind=icon}
