Purpuric rashes Flashcards
Henoch-Schonlein Purpura
What is it?
Classic tetrad?
IgA mediated small vessel vasculitis
Rash - initially macular then purpuric - symmetrical rash on bottocks and back of legs
Abdominal pain - bloody D, N&V
Arthralgia - commonly knees and ankles which may be swollen and tender
Glomerulonephritis weeks later - IgA deposits in kidneys
Henoch-Schonlein Purpura
Inv
HSP:
Kidnes - urinalysis, U&E
CRP
Renal biopsy to confirm
Check for other causes of purpure: FBC - leukemia Blood film - abnormal ITP Abnormal clotting LP and blood culture if meningococcal disease suspected
Henoch-Schonlein Purpura
Management - 1
What about the kidneys
Analgesia
Corticosteroids may be kidney protective
Kawasaki’s Disease
What is it?
When is it most common?
S+S: Temp Eyes Rash - type, where and progression Tongue
Medium vessel vasculitis
Age 2
Persistent fever over 5 days
Dry bilateral conjunctivitis (no exudate)
Non-vesicular, desquamating rash which starts at extremtires (inc palms and soles)
Strawberry tongue
Kawasaki’s Disease
Management:
Acute - what is first line and what is second line?
What is the risk of using the first line drug for Rx?
What is the main complication of KD?
Aspirin, then IVIG (Can also give biological if IVIG not treating it)
Risk of Reye’s syndrome with aspirin use in children. Aspirin not used.
Lifelong aspirin as 25% develop coronary artery aneurysms and are at risk of early MI
Overview. Reye’s (Reye) syndrome is a rare but serious condition that causes swelling in the liver and brain. Reye’s syndrome most often affects children and teenagers recovering from a viral infection, most commonly the flu or chickenpox.
Idiopathic thrombocytopenic purpura (ITP)
What is it due to?
What may a child have before developing ITP
Symptoms
Abnormally low number of platelets in the blood
A virus or viral infection approximately three weeks before developing ITP
Purpura, Large bruises Petechia Nosebleeds Bleeding in mouth and/or around gums Blood in the vomit, urine or stool.
ITP
Management
Steroids
Intravenous gamma globulin (IVGG)
Immune globulin Medication changes Infection treatment to increase platelet counts Splenectomy Hormone therapy
Testicular Torsion
Main causes?
S+S
What reflex is lost?
Incomplete attachment of the testes within the scrotum. This permits the testes to be more movable, allowing them to twist.
Pain Swelling Bruising in newborns Firmness in newborns Redness High-lying testicles Nausea and vomiting
Loss of cremasteric reflex (reflex involved in controlling testicular movement into the pelvic cavity, which is normally elicited by cold, touch, emotional excitement, or exercise)
Testicular Torsion
How is it usually diagnosed?
Rx - 1
Physical examination and complete medical history.
USS
Surgery within 6 hours
