By Dr. Jacqueline Bober
4-year-old patient is BIB Grandma for not walking well. She states every time he tries to walk he cries. Physical Exam is noted for the rash below:
Henoch Schonlein Purpura
What is the pathophysiology?
IgA-mediated vasculitis affecting skin, joints, GI tract and Kidneys. Peak incidence is 4-7 years of age
What are clinical features?
– Nonthrombocytopenic purpuric rash involving buttocks and extensor surfaces of LE
– Arthralgias
– Abdominal Pain
– Non-erosive Arthritis
– Nephritis
How do you diagnose it?
Clinically!
Name some rare but significant complications?
Intusseption
Bowel Perforation
What else should be on your differential?
meningococcemia, Kawasaki disease, and thrombocytopenic purpura … just to name a few—keep them in the back of your mind
What is the management?
Get a UA- if abnormal may need to get Electrolytes for Creatinine
Check BP
Pain control
If any abdominal complications or nephritis- need to admit
Don’t we give steroids?
Not anymore—no proven prevention against nephritis
References
Kliegman RM, Stanton BF, et al. Nelson Textbook of Pediatrics. 19th edition. 2011; 868-871
Fleisher GR, Ludwig S, et al. Textbook of Pediatric Emergency Medicine. 6th edition. 2010; 1117-1118
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