Henoch Schonlein purpura (anaphylactoid purpura)
Henoch Schonlein purpura is actually a syndrome in which multiple organs are affected simultaneously due to immune vasculitis (inflammation with antibody deposition on small blood vessels). Triggering process is performed by predilection in infection with streptococci, staphylococci rarely, vaccines, food allergens, serum therapy, insect bites.
Anaphylactoid purpura is common in preschool aged children and especially in males. There is a seasonal incidence with increased frequency in spring and autumn.
Henoch Schonlein symptoms:
Clinical debut: 1-2-3 weeks after infection and presents:
- purpura: macules, urticaria-like papules without pruritus (itching), with hemorrhagic character;
- bullous petechiae (red spots) which are ecchymotic or necrotic (rare);
- Purpura and petechia appear symmetrically on the lower extremities (legs), buttocks, around the joints;
- Very rarely are affected the trunk or face, but appear instead in Henoch-Schonlein purpura strange localized hemorrhagic edemas (lip, scalp, hand, foot);
- Successive crises are exacerbated by cold and standing;
- Joints are affected in 60-80% of cases of a artritis or arthralgia aspect (joint pain with or without signs of inflammation: redness, heat, pain);
- It may appear some vomiting, nausea, abdominal pain, GI bleeding (vomiting blood can occur – hematemesis or melena stool, black-oil-like);
- In 10-15% of cases can appear severe abdominal pain like appendicitis and which can be complicated by intussusception or bowel perforation;
- A the kidney level, in 70-80% of cases there is a focal oligo-symptomatic glomerulonephritis (not with edema, rarely hypertension) but frequently with macroscopic hematuria (red urine).
Henoch Schonlein purpura treatment consists of absolute rest in bed, diet to avoid food allergy and dietary salt restriction for corticosteroid therapy, treating causing infection, corticosteroids, anticoagulants, antiaggregation, antihistamines and vasculotropes.
Generally, this type of anaphylactoid purpura in children heals without becoming chronic. Prognosis is worse in a limited number of cases (1-2%) mostly due to surgical accidents and rapidly progressive glomerulonephritis when it remains persistent in 25-30% of cases.