Henoch-Schonlein purpura

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)
    

    Palpable Purpura
  • Acute abdominal pain (diffuse, colicky)
    • Usually develops after onset of rash
  • Arthritis
    • Migratory, usually involves knees/ankles
  • Nephritis (>50% of the time)
• Rare manifestations
  • Melena, hematemesis, hepatosplenomegaly
  • Headache, seizures
  • Fever
  • Non-pitting edema of the extremities and face
  • Nephrotic Syndrome
    • Long-term mortality directly related to renal involvement

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

1. UA
   1. Hematuria, proteinuria
2. Chemistry
3. 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

Pediatric Rashes