A patient with Henoch-Schönlein purpura and intra-alveolar haemorrhage

Henoch-Schönlein purpura (HSP) is a systemic vasculitis predominantly occurring in prepubertal children and characterised by a purpuric rash on the lower extremities, arthralgia and abdominal pain. Renal involvement is not uncommon affecting between 20 and 80% of patients [1] and severe nephrotic syndrome or nephritis is frequently associated with significant renal disease, morbidity and mortality. Lung involvement, especially pulmonary haemorrhage, is rare and reported primarily in adolescents and adults and it carries significant mortality [2]. We report a case of an adult with severe HSP complicated by acute renal failure and pulmonary haemorrhage where aggressive supportive management, corticosteroids and cytotoxic therapy with cyclophosphamide provided life-saving treatment. We discuss the association between systemic HSP and lung involvement as well as options for treatment of combined renal and pulmonary vasculitis in HSP.