HENOCH-SCHONLEIN PURPURA

Question 1

History & Physical

Answer 1

Abdominal pain diffuse & colicky

Hematochezia / Melena

Red / dark urine

Arthralgia of lower extremities

Non-blanching palpable purpuric rash, lower extremities and buttocks

Nonpitting edema of face, trunk, extremities

Question 2

Investigations / Diagnosis

Answer 2

Clinical Diagnosis:

Palpable purpura predeminantly on the buttocks and lower extremities with >/1 of:

Abdominal Pain
Arthritis / Arthralgia
IgA predominance on biopsy

U/A: microscopic hematuria, WBC, casts or protein

CBC: serum platelets nml
Cr, Electrolytes if UA abnormal
IgA?

+/- stool hemeoccult

Question 3

Management & Disposition

Answer 3

Self-limiting

Analgesia with NSAIDS and Acetaminophen - avoid NSAIDs with renal or GI involvement

Consider Prednisone 1 mg / kg / day (max 60 mg) for 1-2 weeks with a wean - controversial. Discuss with nephrology if renal involvement.

Follow up with PCP for monitoring of renal function

Close follow up with nephrology if renal involvement