Mycoplasma pneumoniae as a trigger for Henoch-Schonlein purpura in children
Mycoplasma pneumoniae as a trigger for Henoch-Schonlein purpura in children
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DOI：
10.5114/ceji.2015.56976
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发表时间：
2015-01-01
影响因子：
1.3
通讯作者：
Roszkowska-Blaim, Maria
中科院分区：
文献类型：
--
作者：
Kuzma-Mroczkowska, Elzbieta;Panczyk-Tomaszewska, Malgorzata;Roszkowska-Blaim, Maria
肺炎支原体是儿童呼吸道感染最常见的原因之一。肺外表现见于高达25%的感染患者。肺外并发症与中枢神经系统、胃肠道、皮肤改变、心肌炎、心包炎、溶血性贫血、血小板减少症和血栓形成有关。大多数肺外症状与皮肤变化相关，如皮肤出疹、结节性红斑、荨麻疹、Stevens-Jonson综合征。M.肺炎刺激白细胞介素和肿瘤坏死因子（TNF）α的产生，并可引起血管炎。过敏性紫癜（HSP）是一种累及小血管的白细胞性血管炎。HSP的临床表现包括典型的皮疹、关节炎、胃肠道和有时肾脏受累。HSP的主要特征是血管壁异常伊加沉积。循环异常糖基化伊加1和IgG抗体形成免疫复合物：IgAl-IgG和抗IgA 1。免疫复合物激活细胞因子，补体的一部分，并直接影响内皮。我们报告的情况下，三个儿童过敏性紫癜与长期和复发性皮肤和关节的变化。血清学分析（阳性血清IgM）证实肺炎支原体感染。克拉霉素治疗导致疾病完全消退。我们认为，在过敏性紫癜引起的血管炎症状延长的情况下，肺炎支原体感染可能是疾病恶化的潜在原因。
Mycoplasma pneumoniae is one of the most common causes of respiratory tract infections in children. Extrapulmonary manifestations are seen in up to 25% of infected patients. Extrapulmonary complications are associated with the central nervous system, gastrointestinal tract, skin changes, myocarditis, pericarditis, hemolytic anemia, thrombocytopenia and thrombosis. The majority of extrapulmonary symptoms are associated with skin changes such as exanthematous skin eruptions, erythema nodosum, urticaria, Stevens-Jonson syndrome. M. pneumoniae stimulates production of the interleukins and tumor necrosis factor (TNF) alpha and can cause vasculitis. Henoch-Schonlein purpura (HSP) is a leucoclastic vasculitis that affects small vessels. Clinical manifestations of HSP include typical rash, arthritis, gastrointestinal and sometimes renal involvement. The main feature in HSP is abnormal IgA deposits in vessel walls. Circulating abnormal glycosylated IgA 1 and IgG antibodies form immune complexes: IgAl-IgG and anti-IgA 1. Immune complexes activate cytokines, parts of complement and influence directly the endothelium. We report cases of three children with Henoch-Schonlein purpura with prolonged and recurrent skin and joint changes. The serological analysis (positive serum IgM) confirmed Mycoplasma pneumoniae infection. Treatment with clarithromycin caused complete regression of disease. We suggest that in the case of prolonged symptoms of vasculitis due to Henoch-Schonlein purpura, Mycoplasma pneumonia infection may be a potential cause of exacerbation of the disease.