Hyperamylasemia as manifestation of gastrointestinal involvement in adult type Henoch-Schönlein purpura

Abstract

SUMMARY
Henoch-Schönlein purpura is a generalized vasculitis presenting
with purpura, glomerulonephritis, cryoglobulinemia,
arthralgias and acute abdominal pain. It occurs
mainly in childhood and serum IgA is increased in half of
the patients. A 54-year-old male patient was admitted to
the Department of Nephrology because of lower extremities
purpura, mild abdominal pain and acute renal failure
(creatinine clearance at 60 ml/min). Physical examination
showed both lower extremities purpura and mild epigastric
tenderness. Abdominal imaging did not show anything
remarkable. Further laboratory investigation showed serum
urea 75 mg/dl, serum creatinine 1.9 mg/dl, amylase 600 UI/
ml (normal values up to 90 UI/ml) and albumin 3.2 gr/dl.
Serum isoamylase analysis was compatible with that of
pancreatic origin. Urine amylase was 138 UI/ml, while the
examination of the urinary sediment showed microscopic
hematuria and proteinuria. In the 24-hour urine collection
albuminuria reached nephrotic syndrome levels (4.8gr/24h).
There was no evidence of elevated IgA levels, of cryoglobulinemia
or of circulating immune complexes. Skin and
kidney biopsies confirmed Henoch-Schönlein purpura
diagnosis. In conclusion, we report on an adult patient with
hyperamylasemia during Henöch-Schonlein purpura initial
diagnosis. Key words: Henoch-Schönlein purpura, pancreatitis, amylase,
isoamylase, hyperamylasemia, abdominal pain