Gallbladder and pancreas in henoch-schonlein purpura : Review of the literature

Objective: Involvement of the pancreato-biliary system has been occasionally noted in Henoch-Schonlein purpura. Furthermore, cases of this vasculitis syndrome sometimes develop in the context of a viral hepatitis or after hepatitis vaccination. Methods: We completed a review of the literature. Results: Fifty reports published between 1977 and 2015 were retained for the analysis. A pancreato-biliary involvement was recognized in 34 individually well-described patients (O=19:15) with severe abdominal pain: pancreatitis (N=20), acalculous cholecystitis (N=11), both pancreatitis and cholecystitis (N=3). In all of the pancreatitis patients, full recovery occurred (within 3 weeks in three-fourths of the patients). Cholecystectomy was performed in 8 cholecystitis patients. Seventeen Henoch-Schonlein patients (O=9:8) were associated with a viral liver disease and 4 (O=1:3) with a hepatitis vaccination. The vasculitis syndrome rapidly remitted in the 7 patients accompanying hepatitis A or E, in 2 patients of hepatitis B, and in the 4 patients preceded by a vaccination. Henoch-Schonlein purpura seemed to be serious in 5 patients with chronic hepatitis B and in 3 with chronic hepatitis C. Conclusions: This analysis indicates that pancreato-biliary involvement is unusual in Henoch-Schonlein purpura. This complication deserves consideration in patients with especially severe abdominal pain. Finally, viral hepatitides and hepatitis vaccinations seem to be rare triggers of Henoch-Schonlein purpura.