Sunday, November 23, 2014

A 7-year-old girl has palpable purpura and petechiae on her legs and buttocks

A 7-year-old girl has palpable purpura and petechiae on her legs and buttocks and is complaining of
abdominal pain. You know that:

a. The most common presentation also includes arthralgias and microscopic hematuria.
b. This is a hypersensitivity vasculitis with immune complex deposition affecting the blood vessels, especially the veins, exclusively of the lower extremities.
c. An indolent form of meningococcemia may mimic this condition.
d. The condition lasts for approximately 2 weeks.
e. All patients with this condition should be hospitalized for further management.

The answer is a. Henoch-Sch¨onlein purpura is a systemic vasculitis usually seen in children between the ages of 4 and 11 years. There is immune complex deposition of immunoglobulin A in the arterioles and capillaries anywherein the body. Patients usually have abdominal complaints in 70% of cases. The classic presentation is that of a child with abdominal pain, arthralgias, microscopic hematuria, and the characteristic palpable purpuric and petechial rash in the lower extremities and buttocks. A child with meningococcemia may present similarly, although with
more toxicity and abruptness of symptoms. Criteria for admission include severe abdominal pain, severe arthralgias, uncertain diagnosis, or inability to exclude meningococcemia, and intractable vomiting. Steroids are reserved for patients with severe abdominal pain, hematuria, and disabling arthralgias. The course remits and relapses over a course of several weeks to months.


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