發生於老人的過敏性紫斑症罕見案例報告

Henoch-Schönlein Purpura in an Elderly Woman: A Case Report

過敏性紫斑是一種因為免疫球蛋白IgA沉積在不同的器官引起的疾病，這個疾病好發在兒童，在大人較罕見。本案例為83歲女性，之前患有高血壓及慢性腎臟病第3期，這次因為氣促及水腫就醫，抽血發現腎功能急速惡化，雙下肢出現許多凸起的紫斑，經皮膚切片及腎臟切片證實為IgA血管炎合併嚴重腎臟侵犯，經過脈衝類固醇及免疫抑制劑治療病人仍需長期透析治療。過敏性紫斑雖然在兒童為自限性的疾病；但是在成人，嚴重腎功能侵犯進而惡化到末期腎病變的機會較高。以上病例提醒讀者，如果成人突發腎臟功能異常伴有突起性的皮膚紫斑，臨床上必須提高警覺，要考慮過敏性紫斑的可能性。

Henoch-Schönlein purpura is a common disease of immune complex vasculitis in children. It is extremely rare in adulthood and primarily caused by deposition of immunoglobulin A (IgA). Herein, we present a case of Henoch-Schönlein purpura in an 83-year-old woman with symptoms of asthma and edema, acute deterioration of renal function, and palpable purpura on both lower limbs. She was diagnosed as having IgA vasculitis accompanied with severe renal involvements based on pathology findings of skin and kidney. Although she was treated with pulse therapy using steroids and immunosuppressants, she had to receive regular hemodialysis. Although Henoch-Schönlein purpura is a self-limited disorder in childhood. In adults, however, severe renal involvement to end-stage renal disease at the time of diagnosis is higher. In conclusion, the possibility of Henoch-Schönlein purpura should be considered if an adult patient has impaired renal function and palpable purpura located on the skin.