Atypical presentation of Henoch–Schönlein purpura in a paediatric patient initially presenting as gastroenteritis and lymphadenopathy
DOI:
https://doi.org/10.18203/2349-3291.ijcp20260420Keywords:
Henoch Schonlein purpura, Paediatric vasculitis, Gastroenteritis mimic, Arthritis, Palpable purpuraAbstract
Henoch–Schönlein purpura (HSP) is the most common small-vessel vasculitis in children and is classically characterized by palpable purpura, arthritis, and gastrointestinal involvement. However, atypical or temporally delayed presentations may lead to diagnostic uncertainty. We report the case of a 6-year-old girl who initially presented with epigastric pain, high-grade fever, and abdominal lymphadenopathy suggestive of gastroenteritis. After initial improvement and discharge, she re-presented with knee arthritis, persistent fever, and subsequently developed palpable purpura. Septic arthritis was excluded, and skin biopsy findings were consistent with vasculitis, confirming the diagnosis of HSP. Treatment with corticosteroids led to rapid clinical improvement. This case highlights the importance of reassessment and clinical vigilance in children with evolving multi system symptoms.
Metrics
References
Saulsbury FT. Henoch–Schönlein purpura. Lancet. 2007;369:976-8. DOI: https://doi.org/10.1016/S0140-6736(07)60474-7
Piram M, Mahr A. Epidemiology of immunoglobulin A vasculitis (Henoch–Schönlein purpura): an updated review. Curr Opin Rheumatol. 2013;25(1):91-5. DOI: https://doi.org/10.1097/BOR.0b013e32835d8e2a
Ruperto N, Ozen S, Pistorio A, Dolezalova P, Brogan P, Cabral DA, et al. EULAR/PRINTO/PRES criteria for Henoch-Schönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part I: Overall methodology and clinical characterisation. Ann Rheum Dis. 2010;69(5):790-7. DOI: https://doi.org/10.1136/ard.2009.116624
Reamy BV, Williams PM, Lindsay TJ. Henoch-Schönlein purpura. Am Fam Physician. 2009;80(7):697-704.
Trapani S, Micheli A, Grisolia F, Resti M, Chiappini E, Falcini F, et al. Henoch Schonlein purpura in childhood: epidemiological and clinical analysis of 150 cases over a 5-year period and review of literature. Semin Arthritis Rheum. 2005;35(3):143-53. DOI: https://doi.org/10.1016/j.semarthrit.2005.08.007
Dudley J, Smith G, Llewelyn-Edwards A. Abdominal pain preceding rash in Henoch–Schönlein purpura. Arch Dis Child. 2013;98:889-90.
Weiss PF. Pediatric vasculitis. Pediatr Clin North Am. 2012;59:407-23. DOI: https://doi.org/10.1016/j.pcl.2012.03.013
Ronkainen J, Nuutinen M, Koskimies O. The role of steroids in Henoch–Schönlein purpura. Arch Dis Child. 2006;91:240-4.
Pohl M. Henoch–Schönlein purpura nephritis. Pediatr Nephrol. 2015;30:245-52. DOI: https://doi.org/10.1007/s00467-014-2815-6
Ozen S. Update on the management of IgA vasculitis. Curr Opin Rheumatol. 2019;31:542-6.
Downloads
Published
How to Cite
Issue
Section
