Peds In A Pod

Rash and Crying?

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By Dr. Jacqueline Bober

4-year-old patient is BIB Grandma for not walking well. She states every time he tries to walk he cries. Physical Exam is noted for the rash below:

hsp pic

What is the diagnosis?
Henoch Schonlein Purpura

 

What is the pathophysiology?
IgA-mediated vasculitis affecting skin, joints, GI tract and Kidneys. Peak incidence is 4-7 years of age

 

What are clinical features?

– Nonthrombocytopenic purpuric rash involving buttocks and extensor surfaces of LE

– Arthralgias

– Abdominal Pain

– Non-erosive Arthritis

– Nephritis

 

How do you diagnose it?
Clinically!

 

Name some rare but significant complications?
Intusseption

Bowel Perforation

 

What else should be on your differential?
meningococcemia, Kawasaki disease, and thrombocytopenic purpura … just to name a few—keep them in the back of your mind

 

What is the management?
Get a UA- if abnormal may need to get Electrolytes for Creatinine

Check BP

Pain control

If any abdominal complications or nephritis- need to admit

 

Don’t we give steroids?
Not anymore—no proven prevention against nephritis

 

References

Kliegman RM, Stanton BF, et al. Nelson Textbook of Pediatrics. 19th edition. 2011; 868-871

Fleisher GR, Ludwig S, et al. Textbook of Pediatric Emergency Medicine. 6th edition. 2010; 1117-1118

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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