Case Report
Henoch-Schönlein purpura associated with malignancy in adults

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Malignancy is a well-known cause of cutaneous vasculitis. The occurrence of neoplasia and Henoch-Schönlein purpura (HSP) is rare and poorly understood in adults. A total of 31 cases have been reported in the world literature of adult malignancy-associated HSP. Patients were overwhelmingly male (94%) with a mean age of 60 years and presented predominantly with solid tumors (61%). The most frequent tumors were lung (nonsmall-cell) (n = 8), multiple myeloma (n = 5), prostate (n = 5), and non-Hodgkin's lymphoma (n = 3). The majority of patients (55%) developed HSP within 1 month of cancer diagnosis or detection of metastases. We present 3 cases of adults who, in the absence of known precipitating factors, developed HSP within 2 months of diagnosis of a solid tumor or metastases. We recommend that adults, especially older men who present with unexplained HSP, be evaluated for occult neoplasm. We also advise that patients with a known history of malignancy who present with HSP be evaluated for metastatic disease.

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Case 1

A 71-year-old white man with a history of prostate and renal cell carcinoma and hypertension presented with the sudden onset of progressive palpable purpura on his lower extremities, diffuse abdominal pain, and constipation. His medical history included papillary renal cell carcinoma diagnosed 2 months before admission, which was treated with a left partial nephrectomy demonstrating negative margins. He also was diagnosed with Gleason score 7 prostate cancer 1 month before admission for which

Discussion

Neoplasia is a well-documented cause of vasculitis. The incidence of vasculitis in patients with malignancy is estimated to be 2.5% to 5%.2, 6, 8, 9, 10, 11, 12 Although myeloproliferative and lymphoproliferative malignancies were 3 to 5 times more common than solid tumors in all types of vasculitis, solid tumors were more common in association with HSP.11, 12, 13, 14 To date, there have been only 31 reported patients with HSP and coexisting malignancy in the world literature (Table I).8, 13, 14

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    Production and distribution supported by an educational grant to the American Academy of Dermatology by Stiefel Laboratories, Inc.

    Funding sources: None.

    Conflicts of interest: None identified.

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