Henoch-Schonlein purpura: Difference between revisions
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**Palpable purpura (extremities, buttock) | **Palpable purpura (extremities, buttock) | ||
**Acute abdominal pain (diffuse, colicky) | **Acute abdominal pain (diffuse, colicky) | ||
*** | ***Usually develops after onset of rash | ||
**Arthritis | **Arthritis | ||
***Migratory, usually involves knees/ankles | ***Migratory, usually involves knees/ankles | ||
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##Hematuria, proteinuria | ##Hematuria, proteinuria | ||
#Chemistry | #Chemistry | ||
#Consider stool guaiac if concern for melena | |||
==Treatment== | ==Treatment== | ||
*Supportive | *Supportive | ||
*NSAIDs for pain, may worsen renal disease or GI disease | *NSAIDs for pain, may worsen renal disease or GI disease | ||
*consider prednisone 1mg/kg/day for severe arthralgias | *consider prednisone 1mg/kg/day for severe arthralgias, abdominal or scrotal disease | ||
==Disposition== | ==Disposition== | ||
Revision as of 18:07, 11 April 2014
Background
- Most common vasculitis in childhood
- Usually affects 2-11yr
- 5% of cases are a/w intussusception (abd vasculitis)
- Renal involvement is feared complication
- 95% recover completely after 3-4wk
Diagnosis
- Tetrad:
- Palpable purpura (extremities, buttock)
- Acute abdominal pain (diffuse, colicky)
- Usually develops after onset of rash
- Arthritis
- Migratory, usually involves knees/ankles
- Renal disease (50% of the time)
Palpable Purpura
- Rare manifestations
- Melena, hematemesis, hepatosplenomegaly
- Headache, seizures
- Fever
- Non-pitting edema of the extremities and face
DDx
- Meningococcemia
- Erythema nodosum
- Intussusception
- Rheumatic fever
- Polyarteritis nodosa
- SLE
- RA
- Drug reaction
Work-Up
- UA
- Hematuria, proteinuria
- Chemistry
- Consider stool guaiac if concern for melena
Treatment
- Supportive
- NSAIDs for pain, may worsen renal disease or GI disease
- consider prednisone 1mg/kg/day for severe arthralgias, abdominal or scrotal disease
Disposition
- Outpt management for most w/ rheum f/u
See Also
Source
- Rosen's, Tintinalli
- Images provided by University of Iowa Dept. of Dermatology
- First Aid for the Emergency Medicine Boards