Henoch-Schonlein Purpura

Question 1

What is Henoch-Schonlein Purpura?

Answer 1

An IgA vasculitis presenting with a purpuric rash on the lower limbs and buttocks in children

Also associated with glomerulonephritis, abdominal pain, and arthralgia.

Question 2

What causes IgA vasculitis?

Answer 2

IgA deposits in blood vessels leading to inflammation

Often follows an upper respiratory tract infection (URTI) or gastroenteritis.

Question 3

What are the common risk factors for Henoch-Schonlein purpura?

Answer 3

• Preceding URTI or gastroenteritis
• Age 4-6 years
• Male > female (1.5:1)

Question 4

What is the classic feature of Henoch-Schonlein purpura (or IgA vasculitis)?

Answer 4

Purpura (100%)

Red-purple lumps under skin containing blood caused by inflammation and leakage of blood from small blood vessels.

Question 5

Four classic features of Henoch-Schonlein purpura ?

Answer 5

1. Purpura
2. arthralgia
3. abdominal pain
4. renal involvement

Question 6

What are the common joints affected by arthralgia in Henoch-schonlein purpura?

Answer 6

• Knees
• Ankles

Question 7

What are possible GI complications in Henoch-Schonlein purpura?

Answer 7

• GI haemmorhage
• intusussception
• bowel infarction

Question 8

What renal issue is associated with Henoch-Schonlein purpura?

Answer 8

IgA nephritis

Can present with microscopic or macroscopic haematuria.

Question 9

What are the differential diagnoses for non-blanching rash in IgA vasculitis?

Answer 9

• Meningococcal septicaemia
• Idiopathic thrombocytopenic purpura (ITP)
• Haemolytic uraemic syndrome (HUS)

Question 10

Which investigations are commonly conducted for IgA vasculitis?

Answer 10

• FBC, blood film
• U&Es
• Serum albumin
• CRP, blood cultures
• Blood pressure

Question 11

What criteria does the Paediatric Rheumatology European Society (PRES) use for diagnosing IgA vasculitis?

Answer 11

Palpable purpura (not petechiae) + at least one of:
* Diffuse abdominal pain
* Arthritis or arthralgia
* IgA deposits on histology
* Proteinuria or haematuria

Question 12

What is the management approach for IgA vasculitis?

Answer 12

Supportive care including:
* Simple analgesia
* Rest
* Hydration

Question 13

What is important for follow-up in IgA vasculitis management?

Answer 13

Regular follow-up for renal involvement

Includes urine dipsticks and monitoring blood pressure.