Review Question - QID 105586

This patient has the constellation of symptoms including palpable purpura, joint pain, abdominal pain, and renal disease that suggest a diagnosis of Henoch-Schonlein purpura (HSP).

HSP is a IgA-mediated small vessel vasculitis that is commonly seen in the pediatric population after upper respiratory tract infections. The triad of symptoms including joint pain, abdominal pain, and purpura is classic for this diagnosis. Treatment is usually supportive in nature (such as NSAIDs) as most cases resolve on their own. Steroids can be used in severe cases and IVIG may be indicated in the setting of glomerulonephritis. Intussusception is a late sequelae of HSP and can present with severe and intermittent abdominal pain with a target sign on ultrasound.

Figure A displays the purpuric rash that is commonly seen in HSP.

Incorrect Answers:
Answer 1: Hemorrhagic adrenalitis is a sequelae of disseminated Neisseria meningitidis infection and presents with a purpuric rash as well as unstable vitals, nausea, vomiting, hyperkalemia, a metabolic acidosis, and rapid progression to shock and death, if not treated immediately.

Answer 2: Immune thrombocytopenic purpura presents with a decrease in platelets only (which can cause the formation of petechiae) after a viral infection. This condition resolves spontaneously; however, severe cases or patients who are bleeding may receive steroids or IVIG.

Answer 3: Kawasaki disease is a medium vessel vasculitis that classically presents with CRASH and burn (conjunctivitis, rash, adenopathy, strawberry tongue, hand/foot rash, and a fever for 5 or more days).

Answer 5: Rubella presents with a rash that starts on the face and spreads to the body and limbs. Posterior auricular lymphadenopathy can be seen and this condition tends to resolve after 3 days.

Bullet Summary:
Henoch-Schonlein purpura presents with palpable purpura, arthralgias, abdominal pain (and intussusception), and kidney disease.