Letters to the Editor

8 May 2008 Dear Editor, COMMENT ON ACUTE PANCREATITIS: A RARE PRESENTING FEATURE OF HENOCH-SCHÖNLEIN PURPURA We read with interest the article ‘Acute pancreatitis: a rare presenting feature of Henoch-Schönlein purpura’ by Soyer et al.1 Although it has been reported that measurement of plasma factor XIII could be useful for the early diagnosis of Henoch-Schönlein purpura (HSP), particularly when the typical purpuric rash is preceded by abdominal pain,2 there was no report on the usefulness of factor XIII in acute pancreatitis preceding HSP. Probably, however, this factor might have been decreased at the onset of pancreatitis because of HSP. Dalens et al. reported that if the factor XIII level is greater than 80%, the diagnosis of HSP is unlikely, and if factor XIII level is less than 60% of normal, the risk of complications is high.3 The incidence of pancreatitis in HSP is not known because serum amylase and lipase has not been routinely measured in previous studies. During the past 12 years, we experienced only two children with pancreatitis associated with HSP. In these patients, serum amylase and lipase were mildly elevated at the acute stage of HSP and pancreatitis had resolved after oral steroid therapy. Although steroids have also been postulated to cause haemorrhagic pancreatitis in one report,4 we speculate that the pathogenesis such as decreased factor XIII concentrations rather than steroids themselves might cause severe haemorrhage in that patient. In addition to the anti-inflammatory effect of steroids on vasculitis, it was recently reported that factor XIII levels had increased after steroid therapy in some HSP patients.5 Therefore, HSP should be suspected for children with abdominal symptoms such as severe abdominal pain of unknown origin or pancreatitis by the measurement of factor XIII level, and steroid therapy might help in controlling pancreatitis associated with HSP. Further studies are necessary to elucidate the incidence of pancreatic involvement in HSP patients with abdominal pain.