Unique findings on endoscopy with narrow-band imaging in colonic lesions of Henoch-Schönlein purpura.

A 61-year-old woman presented with acute lower abdominal pain, bloody diarrhea, and purpura on the right thigh (●" Fig.1). Urgent sigmoidoscopy revealed edema and multiple hyperemic ecchymotic lesions in the sigmoid colon and rectum (●" Fig.2), which appeared reddish on viewing with conventional white light and cyan on narrow-band imaging (NBI) (●" Fig.3). These lesions were indicative of bleeding in the subepithelial layer, which was confirmed on histopathologic examination (●" Fig.4). On the basis of the endoscopic findings and purpura on the thigh, the patient was clinically diagnosed as having Henoch–Schönlein purpura (HSP). This diagnosis was confirmed following histopathological examination of a skin biopsy specimen. Intravenous administration of prednisolone resulted in rapid improvement of the abdominal symptoms and the purpura of the thigh. Sigmoidoscopy carried out 6 days after the onset of the patient’s symptoms, showed complete resolution of the edema and of themultiple hyperemic ecchymotic lesions (●" Fig.5). HSP is a disease characterized by systemic vasculitis and multiple organ involvement. The endoscopic gastrointestinal findings of HSP have been described previously and include erythema, edema, petechiae, ulcers, nodular changes, hematoma-like protrusions, and hyperemic ecchymotic lesions [1–3]. However, little is known about the endoscopic findings with NBI, which uses two discrete bands Fig.1 Purpura on the right thigh of a 61-yearold woman, who also had acute lower abdominal pain and bloody diarrhea. Fig.2 a,b Endoscopic view of the hyperemic ecchymotic lesions. Sigmoidoscopy shows edema and multiple hyperemic ecchymotic lesions in the sigmoid colon and rectum, resembling the purpura on skin in Henoch–Schönlein purpura (HSP). The hyperemic ecchymotic lesions appear reddish with conventional white light.