Renal manifestations may follow the development of the rash by up to three months; therefore, urinalysis should be performed monthly, as well as measurements of blood urea nitrogen and creatinine levels in the presence of continued hematuria. The main symptom is About 1% may go on to develop total kidney failure. Henoch-Schonlein purpura. The disorder appears to represent a variety of leukocytoclastic angiitis initiated by deposition of immune complexes and can occur in response to infectious agents such as group A streptococci, Mycoplasma, Epstein-Barr virus and Varicella virus. Previous: Travel Medicine: Helping Patients Prepare for Trips Abroad, Next: DOT Examinations: Practical Aspects and Regulatory Review, Home Henoch-Schönlein purpura (HSP) is a rare condition that is caused by inflammation of blood vessels (vasculitis). In rare cases, an abnormal folding of the bowel (intussusception) may cause a bowel blockage, which may require surgery to fix. It's important to monitor the kidney problems closely and make sure they clear up, since about 5% of patients may develop progressive kidney disease. The complete blood count may reveal a normal or elevated white blood cell count and possible eosinophilia. Sheikh SH, Schumacher HR Jr, ed. The purpuric areas evolve from red to purple, become rust-colored with a brownish hue and then fade.9 In more severe cases, hemorrhagic, purpuric or necrotic lesions may be prominent. Torok TJ, Primer on the rheumatic diseases. Kochman RH. Falk RJ. Philadelphia: Saunders, 1979. Eisenberg GM, In some cases, corticosteroid medication may be used. Connolly B, Ferguson PJ, 1998 Aug 1;58(2):405-408. Travel Medicine: Helping Patients Prepare for Trips Abroad, DOT Examinations: Practical Aspects and Regulatory Review. Trujillo H, Most children recover fully. Pollack ES. Kallen R. It's not usually serious, but can sometimes lead to kidney problems. It usually lasts only a few days and does not cause any long-term, chronic joint problems. Lanzkowsky S, A rash of erythematous papules is typically followed by purpura, abdominal pain, arthritis and nephritis. Henoch-Schonlein purpura: four cases and a review. N Engl J Med. 15th ed. Schumacher HR Jr, ed. Andreoli S. Abdominal pain. ", Cedars-Sinai: "Henoch-Schonlein Purpura. Some cases of HSP have been linked to vaccinations for typhoid, cholera, yellow fever, measles, or hepatitis B; foods, drugs, chemicals, and insect bites. Henoch-Schonlein purpura associated with Campylobacter jejuni enteritis. Leiser J, Nonsteroidal anti-inflammatory drugs can relieve joint and soft tissue discomfort. Finkel TH, The symptoms of HSP usually begin suddenly. If organs such as the kidneys and intestines are affected, treatment is often needed and it is important to have regular follow-up to prevent serious complications. An abdominal ultrasonogram with follow-up computed tomographic scan may be necessary to rule out an intussusception in a child with HSP nephritis and severe abdominal pain. J Am Soc Nephrol. Treatment with cyclophosphamide (Cytoxan, Neosar), plasmapheresis, cyclosporine (Neoral) and azathioprine (Imuran) is controversial. Jennette JC, Pedersen RS. In most patients, the kidney impairment is mild and goes away without any long-term damage. Finkel TH, An illustration of Henoch-Schönlein purpura can be seen in Figure 1. Primer on the rheumatic diseases. However, all four elements of this tetrad are not required for diagnosis. Sedimentation rate and platelet count may be elevated. This test can be used to evaluate abdominal pain and rule out other causes. Patrignelli R, A 35-year-old white man with no prior illness presented with a 10-day history of colicky abdominal pain worsened with meals, and back pain. This complication occurs in 50 percent of older children but in only 25 percent of children younger than two years. Some experts also say that HSP is associated with the colder weather of fall and winter. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Purpura may be defined as visible, unblanching hemorrhages in the skin or mucous membranes that are 5 to 10 mm in diameter and often palpable. Lesions typically appear on the lower extremities and buttocks, but may also involve the upper extremities, face and trunk, and are accentuated in areas of pressure (such as sock lines and the waistline). Treatment is supportive, and children affected by this disorder need close follow-up of renal status. Durigon EL, In some cases, patients may have abdominal pain before the rash appears. Wasserman D, Stomach pain usually starts a week after the rash. The main symptom is a rash with numerous small bruises, which have a raised appearance, over the legs or buttocks. Lind KM, 13. Amitai Y, O'Halpin D. Henoch–Schönlein purpura (HSP), also known as IgA vasculitis, is a disease of the skin, mucous membranes, and sometimes other organs that most commonly affects children. Here are some key details about the symptoms of HSP: Rash. Pollack ES. Blood vessels throughout the body are affected but HSP most often causes a skin rash, tummy (abdominal) pain and joint pains. Background. Gunasekaran TS, 1994;6:25–31. Sonographic evaluation of the abdomen in Henoch-Schonlein purpura. A multisystem disease also seen in adults. Henoch-Schönlein purpura in a nine-month-old male Hispanic patient following a febrile upper respiratory infection. Henoch-Schonlein purpura: a diagnosis not to be forgotten. Behrman RE, Kliegman RM, Arvin AM, eds. 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