HSP

Question 1

What is Henoch-Schonlein Purpura?

Answer 1

HSP is a small vessel vasculitis.

Question 2

What are the clinical features associated with HSP? At what age does this present?

Answer 2

Most common age of onset is 2-8 years

Presents with the triad of:
Evolving palpable purpura – predominantly buttocks and legs
Abdominal Pain (occasionally malaena) can precede the formation of the rash
Large joint migratory arthritis (pain and swelling) of variable duration and severity

Other: Nephritis, oedema, acute scrotal swelling and “bruising”, fever and fatigue

Question 3

In terms of the assessment of a child with potential HSP, how do you assess the various aspects of the presentation?

Answer 3

Purpura: If child is unwell or atypical distribution of rash – consider meningococcaemia, thrombocytopenia or other vasculitidies

Joint Pain: Could be main complaint but in most situations the pain resolves spontaneously within 24-48 hours

Abdominal Pain: Uncomplicated abdo pain often resolves spontaneously within 72 hours. There can be serious complications though including intussusception, bloody stools, haematemesis, spontaneous bowel perforation, and pancreatitis. Need to differentiate testicular pain from vascular induced testicular pain to torsion.

Renal Disease: Haematuria is present in 90% of cases but only 5% are persistent or recurrent. Can have renal manifestations but this is less common.

Question 4

What are the 3 investigations required in the context of potential HSP?

Answer 4

FBE (to rule out thrombocytopenia)
Urinalysis – haematuria, proteinuria
Renal Function – urea, creatinine and urinary protein estimation

Question 5

What are the principles of management for HSP?

Answer 5

Supportive – Bed rest and analgesia

Corticosteroids – can reduce the duration of the abdo and joint pain but not sure how it affects the other features

Follow up with GP to ensure resolution of the disease. Must ensure BP measurement as renal manifestations can present up to 6 months after initial presentation.

Question 6

When would you admit a patient with HSP?

Answer 6

Admit if abdominal complication or renal complication such as nephritis or nephrotic syndrome.

Admit for symptomatic treatment for severe joint pain, abdominal pain or painful subcutaneous oedema.