Henoch-Schonlein purpura

Background

• Most common vasculitis in childhood
• Usually affects 2-11yr
• 5% of cases are a/w intussusception (abd vasculitis)
• Renal involvement is feared complication
• 95% recover completely after 3-4wk

Diagnosis

• Tetrad:
  • Palpable purpura (extremities, buttock)
  • Acute abdominal pain (diffuse, colicky)
    • Develops after onset of rash
  • Arthritis
    • Migratory, usually involves knees/ankles
  • Renal disease (50% of the time)

Palpable Purpura

• Rare manifestations
  • Melena, hematemesis, hepatosplenomegaly
  • Headache, seizures
  • Fever
  • Non-pitting edema of the extremities and face

DDx

1. Meningococcemia
2. Erythema nodosum
3. Intussusception
4. Rheumatic fever
5. Polyarteritis nodosa
6. SLE
7. RA
8. Drug reaction

Work-Up

1. UA
   1. Hematuria, proteinuria
2. Chemistry

Treatment

• Supportive
• NSAIDs for pain, may worsen renal disease or GI disease
• consider prednisone 1mg/kg/day for severe arthralgias

Disposition

• Outpt management for most w/ rheum f/u

See Also

Pediatric Rashes

Source

• Rosen's, Tintinalli
• Images provided by University of Iowa Dept. of Dermatology