Spotter of the week

09 JUN 2016

What Dr.Shihana says ?

Dr Remya A S

Case
29 yr old gentleman presented with abdominal pain x 1week
erythematous  rash over both lower limbs, joint swelling
 
Henoch schonlein purpura
It is an immunoglobulin  A  mediated systemic vasculitis  involving  the small blood vessels
supplying  - skin, Gastrointestinal tract,glomeruli and joints

Mostly seen in children (2yrs-8 yrs)
Usually follows upper respiratory tract infection
Predisposing factors include exposure to cold, viral infection,insect bites

Hall mark  - pink ,maculopapular rash below waist:
progresses  to petechiae and purpura
(red –purple –rusty brown )

Arthralgia /arthritis –knee and ankle joints
Gi manifestations :intermittent abdominal pain diarrhea, intussusception
Renal –glomerulonephritis

Diagnostic stratagies

Clinical
Screening studies (cbc,esr, urine r/e )
Skin biopsy –definitive diagnosis

Differential diagnosis
Meningococcemia
Erythema nodosum
Rocky mountain spotted fever
Appendicitis
Juvenile rheumatoid arthritis

Treatment
Symptomatic treatment
Intestinal  and renal  complications –consider  steroids

Disposition
Rash and arthralgias – send home with medications
Intestinal and renal  involvement –admission and evaluation