Henoch-Schonlein purpura (pediatric disease)

Question 1

What are the clinical features of HSP? (Hint HSPP)

Answer 1

H – haematuria. Always after onset of skin changes

S – skin rash (non-thrombocytopenic palpable purpura). Often found on LL and buttocks (w/o thrombocytopenia and coagulopathy)

P – pain in abdo

• Due to oedema of bowel wall, mesenteric vasculitis
• A/w BGIT
• May precede appearance of purpura

P – pain in jts (arthritis)

• Usually large joints (preferentially knees and ankles), migratory arthropathy
• Not arthritis, because no swelling!

Question 2

What are the investigations for HSP?

Answer 2

• CRP, ESR modestly elevated
• Elevated serum IgA
• Urinalysis – hematuria, red cell casts, proteinuria
• Skin biopsy (diagnostic) – leukocytoclastic vasculitis of small blood vessels within the superficial dermis with IgA deposition

Question 3

What is the management of HSP?

Answer 3

Most patients recover spontaneously; treatment is supportive

Paracetamol: alleviate abdominal and joint pain

NSAIDs: alleviate abdominal and joint pain

• BUT may aggravate GI symptoms
• AVOID in active GI bleeding and renal disease

Colchicine

+/- Glucocorticoids: Improve joint and GI symptoms