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Correct answer: B. Prednisone
Rationale
This is a case of Henoch-Schönlein purpura, which is a self-limited, systemic, nongranulomatous, autoimmune complex, small-vessel vasculitis with multiorgan involvement. It is characterized by a classic tetrad of nonthrombocytopenic palpable purpura, arthritis or arthralgias, gastrointestinal involvement, and renal involvement. GI involvement may mimic Crohn's disease, although the biopsies are usually diagnostic. Most cases are self-limiting, but oral steroids are indicated in patients with severe colicky abdominal pain; usually they're started as prednisone or methylprednisolone at 1-2 mg/kg per day for 1-2 weeks and then tapering to a stop in the next 1-2 weeks. Steroids may prevent major complications such as gastrointestinal bleeding or intussusception. Immunosuppressive drugs (cyclophosphamide, azathioprine, cyclosporine A, and mycophenolate mofetil) in combination with high-dose IV pulse steroids are recommended if there is no benefit from steroids alone.
Reference
Sohagia AB et al. Gastroenterol Res Pract. 2010. doi: 10.1155/2010/59764.
Correct answer: B. Prednisone
Rationale
This is a case of Henoch-Schönlein purpura, which is a self-limited, systemic, nongranulomatous, autoimmune complex, small-vessel vasculitis with multiorgan involvement. It is characterized by a classic tetrad of nonthrombocytopenic palpable purpura, arthritis or arthralgias, gastrointestinal involvement, and renal involvement. GI involvement may mimic Crohn's disease, although the biopsies are usually diagnostic. Most cases are self-limiting, but oral steroids are indicated in patients with severe colicky abdominal pain; usually they're started as prednisone or methylprednisolone at 1-2 mg/kg per day for 1-2 weeks and then tapering to a stop in the next 1-2 weeks. Steroids may prevent major complications such as gastrointestinal bleeding or intussusception. Immunosuppressive drugs (cyclophosphamide, azathioprine, cyclosporine A, and mycophenolate mofetil) in combination with high-dose IV pulse steroids are recommended if there is no benefit from steroids alone.
Reference
Sohagia AB et al. Gastroenterol Res Pract. 2010. doi: 10.1155/2010/59764.
Correct answer: B. Prednisone
Rationale
This is a case of Henoch-Schönlein purpura, which is a self-limited, systemic, nongranulomatous, autoimmune complex, small-vessel vasculitis with multiorgan involvement. It is characterized by a classic tetrad of nonthrombocytopenic palpable purpura, arthritis or arthralgias, gastrointestinal involvement, and renal involvement. GI involvement may mimic Crohn's disease, although the biopsies are usually diagnostic. Most cases are self-limiting, but oral steroids are indicated in patients with severe colicky abdominal pain; usually they're started as prednisone or methylprednisolone at 1-2 mg/kg per day for 1-2 weeks and then tapering to a stop in the next 1-2 weeks. Steroids may prevent major complications such as gastrointestinal bleeding or intussusception. Immunosuppressive drugs (cyclophosphamide, azathioprine, cyclosporine A, and mycophenolate mofetil) in combination with high-dose IV pulse steroids are recommended if there is no benefit from steroids alone.
Reference
Sohagia AB et al. Gastroenterol Res Pract. 2010. doi: 10.1155/2010/59764.
Q2. A 26-year-old White male presented with fever and sore throat for 5 days along with erythematous, nonpruritic rash involving the extremities and arthralgias. He subsequently developed right lower-quadrant pain, aggravated with meals, and associated with watery diarrhea. Labs show showed white blood cell count of 14,900/microL and a C-reactive protein level of 12.6 mg/dL. A magnetic resonance enterography showed 20 cm of thickened ileum. An upper endoscopy showed multiple erosions in the duodenum and antrum while a colonoscopy showed erythema and inflammation in the terminal ileum and cecum. Biopsies from both areas demonstrated evidence of leukocytoclastic vasculitis. Skin biopsy also showed leukocytoclastic vasculitis.