Henoch-schonlein purpura and foot pain in child

timharmey · Apr 29, 2013

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My wifes niece ( 8) developed painful feet went to doc and was diagnosed with the above an auto-immune disease have to admit it was a new one on me, worth being aware of methinks

Craig Payne · Apr 29, 2013

Re: Henoch-schonlein purpura

This is from the notes that I used to give students:

Henoch-Schonlein purpura (HSP)/Anaphylactoid purpura:
• disease of childhood (could also occur in adults) peakage of onset around 5 years– consists of vasculitis limited to skin, gastrointestinal tract and kidneys that usually follows an upper respiratory tract infection
• IgA immune complexes deposit in the tissues (may be a hypersensitivity reaction to an infection). Infection and and exposure to drugs are considered common triggers.
• abrupt onset – flu like symptoms. Within days  palpable purpura over tibia, ankles and feet; abdominal pain and GI bleeding.
• 75% develop joint symptoms - mostly knees and ankles – occasionally small joints of hands and feet – usually bilateral and symmetrical – usually only lasts up to a week (no permanent sequelae)
• American College of Rheumatology criteria for diagnosis is when 2 of the 4 criteria are present (palpable purpura, <20 years of age; bowel angina; wall granulocytes on biopsy)
• PAPAH – Purpura, Abdominal Pain, Arthralgias, Haematouria
• usually self limiting – 80% make full recovery in 6 to 16 weeks; management is mostly supportive
• NSAID’s may help joint pain
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Admin2 · Apr 29, 2013

Henoch–Schönlein purpura

Medical condition

Henoch–Schönlein purpura (HSP), also known as IgA vasculitis, is a disease of the skin, mucous membranes, and sometimes other organs that most commonly affects children. In the skin, the disease causes palpable purpura (small, raised areas of bleeding underneath the skin), often with joint pain and abdominal pain. With kidney involvement, there may be a loss of small amounts of blood and protein in the urine (hematuria and proteinuria), but this usually goes unnoticed; in a small proportion of cases, the kidney involvement proceeds to chronic kidney disease. HSP is often preceded by an infection, such as a throat infection.
HSP is a systemic vasculitis (inflammation of blood vessels) and is characterized by deposition of immune complexes containing the antibody immunoglobulin A (IgA); the exact cause for this phenomenon is unknown. In children, it usually resolves within several weeks and requires no treatment apart from symptom control but may relapse in a third of cases and cause irreversible kidney damage in about one in a hundred cases. In adults, the prognosis is different from in children. The average duration of cutaneous lesions is 27.9 months.^[3] For many, it tends to be relapsing–remitting over a long period of time, rather than self-limiting and there tend to be more complications.^[4]

^ Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al. (January 2013). "2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides". Arthritis and Rheumatism. 65 (1): 1–11. doi:10.1002/art.37715. PMID 23045170.

^ ^a ^b ^c Rapini RP, Bolognia JL, Jorizzo JL (2007). Dermatology. St. Louis: Mosby. ISBN 978-1-4160-2999-1.

^ Sais G, Vidaller A, Jucglà A, Servitje O, Condom E, Peyri J (March 1998). "Prognostic factors in leukocytoclastic vasculitis: a clinicopathologic study of 160 patients". Archives of Dermatology. 134 (3): 309–315. doi:10.1001/archderm.134.3.309. PMID 9521029.

^ Collins TR (August 2016). "Treatment Challenges, Uncertainty Abound with IgA Vasculitis". The Rheumatologist.

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NewsBot · Aug 4, 2023

Compartment syndrome: an atypical presentation as a cause of Henoch-Schönlein purpura
M Botero-Bermúdez et al
Acta Ortop Mex. 2022 Sep-Oct;36(5):324-328.

Introduction: there are few case reports available that describe compartment syndrome as a complication of Henoch-Schönlein purpura.

Case report: we report the case of a 17-year-old patient with bilateral compartment syndrome of the foot as an atypical presentation of Henoch-Schönlein purpura. A case like this has not been reported before.

Conclusion: although the patient had an extremely rare clinical presentation, the viability and functionality of the limbs was preserved even after six months of follow-up thanks to an early diagnosis and surgical treatment.
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Henoch–Schönlein purpura

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