Lionel H. Lee, DO

This palpable, nontender,   nonblanching rash had developed   on the elbows of an   18-year-old boy and spread   to the ankles and feet. The   rash was accompanied by moderate   abdominal pain associated with   episodes of nonbloody emesis that   did not change with eating or bowel   movements. Diffuse joint pain   developed the day after the rash appeared.

He had no cough, hemoptysis,   fever, chills, hematuria, or diarrhea.   He denied recent travel and illicit   drug use. A week earlier, he was   evaluated by his primary care physician,   who diagnosed Rocky Mountain   spotted fever and prescribed an   antibiotic. However, his symptoms   persisted despite treatment.

 
   There   was mild, diffuse pain on palpation   of the abdomen. Results of blood   tests, urinalysis, and a chemistry   panel were all normal.   Henoch-Schnlein purpura   (HSP) was diagnosed on the basis   of the classic clinical presentation of   rash, polyarthralgia, and abdominal   pain. The American College of   Rheumatology criteria include palpable   purpura, age of onset before   20 years, bowel angina, and wall   granulocytes on biopsy; the presence   of 2 or more criteria yields a   sensitivity of 87% and a specificity   of 88%.

 While a biopsy to verify the   diagnosis is desirable, in the clear   absence of signs and symptoms suggestive   of other entities, the diagnosis   of classic HSP can be made on   clinical grounds in the proper demographic   context.

HSP is the most common systemic   vasculitis in children, with an   incidence of about 14 cases per   100,000; males are affected twice as   often as females.

 In addition to   Rocky Mountain spotted fever, the   differential diagnosis includes idiopathic   thrombocytopenic purpura,   poststreptococcal glomerulonephritis,   and Wegener granulomatosis.

The long-term prognosis is   good in most cases

. 
   About 80% of   patients recover within 2 weeks, although   nearly 35% of patients have   one or more recurrences.4 HSP progresses   to end-stage renal failure in   only 1% to 5% of affected children.

  This patient responded well to   supportive therapy, including fluid   hydration, pain control, and antiemetic   medications. After several follow-   up visits with his primary care   physician and a nephrologist, he was   noted to have recovered fully.

 Roberts PF, Waller TA, Brinker TM, et al.Henoch-SchÃ¶nlein purpura: a review article. 

 Kraft DM, Mckee D, Scott C. Henoch-SchÃ¶nlein  purpura: a review. 

 Saulsbury FT. Henoch-SchÃ¶nlein purpura. 

 Ebert EC. Gastrointestinal manifestations of  Henoch-Schonlein Purpura. 

 Dillon MJ. Henoch-SchÃ¶nlein purpura (treatment  and outcome). 

Articles

This palpable, nontender, nonblanching rash had developed on the elbows of an 18-year-old boy and spread to the ankles and feet. The rash was accompanied by moderate abdominal pain associated with episodes of nonbloody emesis that did not change with eating or bowel movements. Diffuse joint pain developed the day after the rash appeared.

Lionel H. Lee, DO

Articles

Henoch-Schönlein Purpura in an 18-Year-Old Boy