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A 6 year old boy presents with 2 days of nontender palpable purpura of bilateral lower extremities, accompanied by arthralgia of the left ankle. Vital signs are temperature 37.6, HR 90, RR 20, BP 105/60. He has no nuchal rigidity. He has no significant past medical history. His CBC shows normal platelet count and PT/PTT are normal.
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June 8, 2021 at 3:12 pm
The presentation of the patient in the vignette is most consistent with Henoch-Schonlein Purpura, an IgA vasculitis. Common complications include renal involvement with hypertension resulting, arthritis / arthralgia, abdominal pain, lower GI bleeding / BRBPR, and intussusception due to submucosal edema/hemorrhage acting as a lead point, and scrotal swelling which may mimic testicular torsion. Intracranial hemorrhage is not a common complication. The characteristic rash occurs in virtually all patients eventually, but only 75% have the rash at first presentation, making diagnosis more difficult when the patient initially presents with one of the above complications but without the rash.