PANCREATITIS IN HENOCH-SCHONLEIN PURPURA. A SINGLE CENTRE OBSERVATIONAL STUDY

Introduction: Henoch-Schönlein purpura (HSP) is the most frequent vasculitis in children. Typically, it is characterized by palpable purpura, joints swelling, arthralgia, abdominal pain with possible intestinal bleeding. In more severe cases, the patients show acute abdomen. Acute pancreatitis is a rare dramatically evolutive, life-treating manifestation of SHS and it can be associated with a fulminant course. Persistent abdominal pain, need to be investigated by the dosage of serum pancreatic amylase, lipase and by abdominal MRI. In these patients, corticosteroid treatment is recommended and must be associated with parenteral feeding. Objectives: We analysed the full series of children with HSP admitted to our paediatric unit in the period 2011-2018. Methods: We retrospectively collected data of 50 children (age: 4-14 years), with HSP who needed hospitalization. 4/45 patients (9%) developed an acute pancreatitis. All the patients were males, age:3-10 years. All the patients did not show other risk factors of pancreatitis. Results: The treatment was parenteral feeding in 100% of the patients. One patient with pancreatitis and nephrotic syndrome received 3 bolus doses of methylprednisolone (30 mg/kg/dose) followed by prednisolone (2 mg/kg/day) and mycophenolate; one patient with pancreatitis and acute renal failure, received 3 bolus doses of methylprednisolone (30 mg/kg/dose) followed by a single-dose of cyclophosphamide (750 mg/m2), followed by azathioprine (50 mg/day). One patient showed a mild pancreatitis and healed with prednisolone (2 mg/kg/day) and parenteral feeding. One patient showed acute pancreatitis, associated with acute intestinal bleeding, orchitis, was treated with 3 bolus doses of methylprednisolone (30 mg/kg/dose) followed by prednisolone (2 mg/kg/day). Steroids treatment was progressively tapered until the complete resolution of the pancreatic involvement. Conclusion: Acute pancreatitis is a rare and life-treating manifestation of HSP. High-doses steroids are a recognised and useful treatment, associated with parenteral feeding. In non-responders to steroids, immune suppression treatment is the second-line treatment to induce remission. The choice depends on associated manifestations of HSP and on associated failure of other organs.