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

-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

-CBC, Chem7

-UA

-Blood cx

-ESR

-consider CT abdomen (ileoileal intussusception difficult to detect by US)

-meningococcemia (febrile, ill appearing)

-erythema nodosum

-dz self limited: 94% recover completely

-consider corticosteroids for severe disease (abdominal pain, hematuria, arthralgias)

    -prednisone 1mg/kg/day

-most patients managed safely as outpatient

-consider admission for:

    -uncertain diagnosis to exclude possibility of meningococcemia

    -severe abdominal pain and vomiting

Adapted from Rosens 7th edition

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