Henoch-Schonlein purpura

Background

-HSP, aka anaphylactoid purpura

-systemic vasculitis associated with abdominal pain and rash

-usually age 4-11, may occur in adults

-commonly occurs in springtime after viral URI

Diagnosis

-clinical diagnosis based on presence of abdominal pain, classic rash, microscopic hematuria, arthralgias in otherwise well appearing child

-symptoms: abdominal pain, nausea, vomiting, diarrhea, rash, mild arthralgias

-rash: palpable purpura on buttocks and lower extremities

-intussusception: ileoileal more common than ileocolic inpatients with HSP

Work-Up

1. CBC, Chem7
2. UA
3. Blood cx
4. ESR
5. consider CT abdomen (ileoileal intussusception difficult to detect by US)

DDx

1. meningococcemia (febrile, ill appearing)
2. erythema nodosum

Treatment

• dz self limited: 94% recover completely
• consider corticosteroids for severe disease (abdominal pain, hematuria, arthralgias)
  • prednisone 1mg/kg/day

Disposition

• most patients managed safely as outpatient
• consider admission for:
  • uncertain diagnosis to exclude possibility of meningococcemia
  • severe abdominal pain and vomiting

Source

Adapted from Rosens 7th edition