Examination of child revealed mild anemia, purpuric rash over both lower limbs without any lymphadenopathy or hepatosplenomegaly.
Urine examination revealed sheets of red cells/hpf and mild proteinuria. No significant abnormality was found in CBC examination.
The rash is shown in the picture below:
1. What is the most probable diagnosis?
2. How to manage it?
3. What is its prognosis?
Answers And Discussion:
1. What is the most probable diagnosis?
Answer: Palpable purpura is suggestive of small vessel vasculitis. Presence of hematuria and proteinuria is indicative of nephritis. Presence of bilateral palpable purpuric spots especially over lower limbs associated with diarrhea and nephritis is highly suggestive of “Henoch-Schonlein purpura” (HSP) also known as anaphylactoid purpura.
HSP is most common cause of nonthrombocytopenic purpura in children. It occurs because of vasculitis of small vessels especially in skin, GIT and kidneys.
It is characterized by sudden development of purpuric or urticarial rash especially over the buttocks and lower extremities and is frequently associated with arthralgia or arthritis, crampy abdominal pain, gastroenteritis, glomerulonephritis and sometimes with nephrotic syndrome. No thrombocytopenia is
associated with it.
Palpable purpuric rash is the hallmark of the disease and tends to come in crops and often lasts from 3 to 10 days.
2. How to manage it?
Answer: Majority of these patients recover completely. Its management is mainly supportive and symptomatic.
- Bed rest,
- proper care of nutrition,
- hydration
- pain management with acetaminophen
- Steroids are advised, if severe gastrointestinal symptoms, CNS complications or progressive renal involvement is present.
- Administration of baby aspirin once a day can help, if thrombotic events have occurred.
3. What is its prognosis?
Answer: Prognosis of this self-limited disease is overall excellent. It mainly depends
on the renal involvement.
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