Henoch-Schonlein purpura: Difference between revisions
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==Background== | ==Background== | ||
*Most common vasculitis in childhood | *Most common vasculitis in childhood | ||
**Small vessel | |||
*Most cases preceded by a URI | *Most cases preceded by a URI | ||
*Usually affects 2- | *Usually affects 2-11 yr | ||
*5% of cases | *5% of cases associated with intussusception (abdominal vasculitis) | ||
*Renal involvement is feared complication | *Renal involvement is feared complication | ||
*95% recover completely after 3-4wk | *95% recover completely after 3-4wk | ||
== | ==Clinical Presentation== | ||
*Tetrad: | *Tetrad: | ||
**Palpable purpura (extremities, buttock) | **Palpable purpura bilaterally (extremities, buttock) | ||
**Acute abdominal pain (diffuse, colicky) | **Acute abdominal pain (diffuse, colicky) | ||
***Usually develops after onset of rash | ***Usually develops after onset of rash | ||
**Arthritis | **Arthritis | ||
***Migratory, usually involves knees/ankles | ***Migratory, usually involves knees/ankles | ||
** | **Nephritis (>50% of the time)<ref>Chen JY et al. Henoch-Schönlein purpura nephritis in children: incidence, pathogenesis and management. World J Pediatr. 2015 Feb;11(1):29-34. doi: 10.1007/s12519-014-0534-5. Epub 2014 Dec 29.</ref> | ||
[[File:HSPVasc01.jpg|center|frame|500px|Palpable Purpura]] | [[File:HSPVasc01.jpg|center|frame|500px|Palpable Purpura]]<ref>University of Iowa Dept. of Dermatology</ref> | ||
*Rare manifestations | *Rare manifestations | ||
** Melena, hematemesis, hepatosplenomegaly | ** Melena, hematemesis, hepatosplenomegaly | ||
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** Fever | ** Fever | ||
** Non-pitting edema of the extremities and face | ** Non-pitting edema of the extremities and face | ||
**Nephrotic Syndrome | |||
***Long-term mortality directly related to renal involvement<ref>Calviño, MC, Llorca, J, García-Porrúa, C, Fernández-Iglesias, JL, Rodriguez-Ledo, P, González-Gay, MA (2001) Henoch-Schönlein purpura in children from northwestern Spain: a 20-year epidemiologic and clinical study. Medicine (Baltimore) 80: pp. 279-290 </ref><ref>Saulsbury, FT (1999) Henoch-Schönlein purpura in children. Report of 100 patients and review of the literature. Medicine (Baltimore) 78: pp. 395-409 </ref> | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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*Supportive | *Supportive | ||
*NSAIDs for pain, may worsen renal disease or GI disease | *NSAIDs for pain, may worsen renal disease or GI disease | ||
* | *Consider prednisone 1mg/kg/day for severe arthralgias, abdominal or scrotal disease | ||
==Disposition== | ==Disposition== | ||
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[[Pediatric Rashes]] | [[Pediatric Rashes]] | ||
== | ==References== | ||
<references/> | |||
[[Category:Derm]] | [[Category:Derm]] | ||
[[Category:Peds]] | [[Category:Peds]] | ||
Revision as of 00:23, 23 April 2015
Background
- Most common vasculitis in childhood
- Small vessel
- Most cases preceded by a URI
- Usually affects 2-11 yr
- 5% of cases associated with intussusception (abdominal vasculitis)
- Renal involvement is feared complication
- 95% recover completely after 3-4wk
Clinical Presentation
- Tetrad:
- Palpable purpura bilaterally (extremities, buttock)
- Acute abdominal pain (diffuse, colicky)
- Usually develops after onset of rash
- Arthritis
- Migratory, usually involves knees/ankles
- Nephritis (>50% of the time)[1]
Palpable Purpura
- Rare manifestations
Differential Diagnosis
- Erythema nodosum
- Intussusception
- Rheumatic fever
- Polyarteritis nodosa
- SLE
- Rheumatoid arthritis
- Drug reaction
Pediatric Rash
- Atopic dermatitis
- Bed bugs
- Contact dermatitis
- Drug rash
- Erythema infectiosum (Fifth disease)
- Hand-foot-and-mouth disease
- Henoch-schonlein purpura (HSP)
- Herpangina
- Herpes simplex virus (HSV)
- Infectious mononucleosis
- Meningitis
- Measles
- Molluscum contagiosum
- Roseola infantum
- Rubella (German measles)
- Scabies
- Scarlet fever
- Smallpox
- Varicella (Chickenpox)
Causes of Glomerulonephritis
- Poststreptococcal glomerulonephritis
- Hemolytic-uremic syndrome
- Henoch-Schonlein purpura
- IgA nephropathy
- Lupus nephritis
- Alport syndrome
- Goodpasture syndrome
- Paraneoplastic
Work-Up
- UA
- Hematuria, proteinuria
- Chemistry
- Consider stool guaiac if concern for melena
Treatment
- Supportive
- NSAIDs for pain, may worsen renal disease or GI disease
- Consider prednisone 1mg/kg/day for severe arthralgias, abdominal or scrotal disease
Disposition
- Outpt management for most w/ rheum f/u
- Recurrence rate of up to 33%
See Also
References
- ↑ Chen JY et al. Henoch-Schönlein purpura nephritis in children: incidence, pathogenesis and management. World J Pediatr. 2015 Feb;11(1):29-34. doi: 10.1007/s12519-014-0534-5. Epub 2014 Dec 29.
- ↑ University of Iowa Dept. of Dermatology
- ↑ Calviño, MC, Llorca, J, García-Porrúa, C, Fernández-Iglesias, JL, Rodriguez-Ledo, P, González-Gay, MA (2001) Henoch-Schönlein purpura in children from northwestern Spain: a 20-year epidemiologic and clinical study. Medicine (Baltimore) 80: pp. 279-290
- ↑ Saulsbury, FT (1999) Henoch-Schönlein purpura in children. Report of 100 patients and review of the literature. Medicine (Baltimore) 78: pp. 395-409