Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features +++ Essentials of Diagnosis ++ Purpuric cutaneous rash Migratory polyarthritis or polyarthralgias Intermittent abdominal pain Nephritis +++ General Considerations ++ Most common type of small vessel vasculitis in children Primarily affects boys 2–7 years of age Occurrence is highest in the spring and fall Upper respiratory infection precedes the diagnosis in two-thirds of children Antigens from group A β-hemolytic streptococci and other bacteria, viruses, drugs, foods, and insect bites have been proposed as inciting agents +++ Clinical Findings +++ Symptoms and Signs ++ Skin involvement May be urticarial initially Progresses to maculopapules Coalesces to a symmetric, palpable purpuric rash distributed on the legs, buttocks, and elbows New lesions may continue to appear for 2–4 weeks, and may extend to involve the entire body Migratory polyarthralgias or polyarthritis, primarily of the ankles and knees develop in two-thirds of patients Intermittent, sharp abdominal pain occurs in approximately 50% of patients, and hemorrhage and edema of the small intestine can often be demonstrated Intussusception may develop Renal involvement Develops during second or third week of illness with either a nephritic or, less commonly, nephrotic picture in 25–50% of patients May be accompanied by hypertension In males, testicular torsion may also occur Neurologic symptoms are possible due to small vessel vasculitis +++ Differential Diagnosis ++ The rash of septicemia (especially meningococcemia) may be similar to skin involvement in Henoch-Schönlein purpura, although the distribution tends to be more generalized The possibility of trauma should be considered in any child presenting with purpura Other vasculitides should also be considered The lesions of thrombotic thrombocytopenic purpura are not palpable +++ Diagnosis ++ Platelet count is normal or elevated Other screening tests of hemostasis and platelet function are typically normal Urinalysis frequently reveals hematuria and sometimes proteinuria Stool may be positive for occult blood The antistreptolysin O (ASO) titer is often elevated and the throat culture positive for group A β-hemolytic streptococci Serum IgA may be elevated +++ Treatment ++ Supportive Nonsteroidal anti-inflammatory drugs may be useful for the arthritis Corticosteroid therapy may provide symptomatic relief for severe gastrointestinal or joint manifestations but does not alter skin or renal manifestations If culture for group A β-hemolytic streptococci is positive or if the ASO titer is elevated, a therapeutic course of penicillin is warranted +++ Outcome +++ Prognosis ++ Generally good, although symptoms frequently (25–50%) recur over a period of several months Microscopic hematuria may persist for years in patients with renal manifestations Progressive kidney failure occurs in < 5%, with an overall fatality rate of 3% +++ Reference + +McCarthy HJ: Clinical practice: diagnosis and management of Henoch-Schönlein purpura. Eur J Pediatr 2010;169:643–650 [PubMed: ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth