Alveolar Hemorrhage in Adult Onset Henoch Schonlein Purpura: An Uncommon Presentation

Henoch-Schonlein Purpura (HSP) is a systemic vasculitis that infrequently occurs in adults. While rheumatological and gastrointestinal complications are common, lung involvement is a rare complication. We present a case of 77 year old female who presented to the hospital with hemoptysis. Concomitantly, she was found to have purpuric lesions on her legs and abdomen. Bronchoscopic evaluation revealed evidence of Diffuse Alveolar Hemorrhage (DAH). Skin biopsy of the lesion confirmed the patient to have leukocytoclastic vasculitis on histology consistent with HSP. Patient was managed with steroids in addition to supportive management leading towards the resolution of her symptoms. This case is unique as it presents a rare complication of HSP as the initial presentation i.e. pulmonary disease causing DAH. Furthermore, adult onset HSP is also an uncommon occurrence. It is very important to recognize DAH early in HSP as it holds a high mortality rate.