Intravenous immunoglobulin for corticosteroid-resistant intestinal Henoch-Schönlein purpura: worth a controlled trial against corticosteroids?

Abstract

OBJECTIVES:

Henoch-Schönlein purpura (HScP) may present in children with severe, occasionally refractory, gastrointestinal (GI) involvement. The use of corticosteroids (CSs) is commonplace in the management of the disease, but to date no standardized protocol is available and, although rare, resistance to CS therapy may be challenging to clinicians. IVIG has been proposed as an effective alternative to CSs, but to date no controlled trial has been conducted to ascertain their real efficacy. We share our personal experience of successful IVIG treatment in two cases of GI HScP, comparing it with similar experiences reported in literature.

METHODS:

Retrospective clinical data collection, comparison with available literature.

RESULTS:

We describe two children with severe HScP GI vasculitis refractory to high-dose intravenous CSs that responded rapidly to IVIG administration, with complete recovery within a few days. Patient characteristics and response to IVIG administration were comparable to those of other previously reported cases.

CONCLUSION:

Our observation confirms that IVIG may be useful in the treatment of CS-resistant HScP-related GI vasculitis in children, and highlights the need for more structured research, including a randomized trial against CSs, in order to ascertain their real effectiveness.

• Authors: Francesco Morotti, Giulia Bracciolini, Roberta Caorsi, Lorella Cattaneo, Marco Gattorno, Angelo Ravelli, Enrico Felici
• Journal: Rheumatology (Oxford, England) (Rheumatology (Oxford)) Vol. 60 Issue 8 Pg. 3868-3871 (08 02 2021) ISSN: 1462-0332 [Electronic] England
• PMID: 34340243 (Publication Type: Case Reports, Journal Article)
• Copyright: © The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: [email protected].

Chemical References

• Glucocorticoids
• Immunoglobulins, Intravenous
• Immunologic Factors

Topics

• Adolescent
• Child, Preschool
• Controlled Clinical Trials as Topic
• Drug Resistance
• Glucocorticoids (therapeutic use)
• Humans
• IgA Vasculitis (drug therapy)
• Immunoglobulins, Intravenous (therapeutic use)
• Immunologic Factors (therapeutic use)
• Intestinal Diseases (drug therapy)
• Male