Can Adenovirus Cause Henoch-Schönlein Purpura (HSP)?
Yes, adenovirus is recognized as one of several infectious triggers that can precipitate Henoch-Schönlein purpura, though it is not among the most commonly identified infectious agents associated with this condition.
Understanding HSP and Infectious Triggers
HSP is an IgA-mediated autoimmune hypersensitivity vasculitis affecting small vessels, presenting with purpuric rash (typically on lower extremities and buttocks), abdominal pain, arthritis, and potential renal involvement 1, 2. While the exact etiology remains unknown, infectious agents are identified as triggering factors in approximately 50% of cases 1, 3.
Evidence for Adenovirus as a Trigger
Adenovirus has been documented as a respiratory pathogen tested in HSP workups, though it appears infrequently compared to other infectious agents 3. In a large Chinese cohort of 1,200 HSP children, respiratory pathogens including adenovirus were systematically evaluated, and while adenovirus was among the tested agents, it was not identified as a predominant trigger 3.
More Common Infectious Triggers
The hierarchy of infectious associations with HSP is important for clinical context:
- Streptococcus is the most frequent infectious trigger, identified in 17.08% of cases 3
- Helicobacter pylori accounts for 5.92% of infectious cases 3
- Mycoplasma pneumoniae is found in 4.83% of cases 3
- Group A streptococci and Mycoplasma are classically associated with HSP 2
- Other documented triggers include rotavirus (documented in case reports), parasitic infections, and various respiratory viruses 4, 1, 2
Clinical Implications
When evaluating a patient with suspected HSP:
- Obtain infectious history focusing on recent upper respiratory infections, streptococcal pharyngitis, gastrointestinal infections, and other viral illnesses 1, 2, 3
- Consider testing for antistreptolysin O titer, Mycoplasma antibodies, and respiratory viral panels including adenovirus when clinically indicated 3
- Recognize seasonal patterns: HSP occurs more commonly in fall and winter in children, correlating with peak respiratory infection seasons 5, 3
Treatment Considerations
Symptomatic treatment plus adjunctive anti-infectious agents significantly improves remission rates when an infectious trigger is identified (remission improvement p<0.01) 3. Complete elimination of infectious triggers may help relieve cutaneous purpura 3.
Important Caveats
- Any component of the classic triad (purpura, abdominal pain/renal involvement, arthritis) may be absent, complicating diagnosis 2
- The disease is usually self-limited in children with good prognosis (83% complete recovery at 12 months), though adults have worse outcomes 1, 5
- Renal monitoring is essential as 2% of children progress to renal failure, and up to 20% with nephritis may require dialysis 1