This is an idiopathic purpuric ± urticarial rash over buttocks, extensor knees, and ankles associated with:
- fever and malaise
- transient arthritis, arthralgia (2/3rds)
- colicky abdominal pain (50%) ± intussusception
- gastrointestinal tract bleeding (GITB) → melaena
- haematuria (renal involvement) (25-50%) → nephrotic syndrome (CRF 2-4%)
75% of cases occur in children under the age of 10 years. Up to 25% of cases, however, may present without purpura. HSP is thought to be an allergic IgA-mediated vasculitis in response to bacteria or drugs.
Management
Most cases are self-limiting and require only symptomatic management but close follow-up is needed to identify significant but often asymptomatic renal involvement requiring intervention.
- bed rest
- analgesia
- regular urinalysis
Causes of Purpura
petechiae
- vascular defect
- anaphylactoid purpura
- infective states
- vitamin C deficiency
- hereditary haemorrhagic telangiectasia, polyarteritis nodosa, uraemia, Cushing’s syndrome, Ehlers-Danlos syndrome
- platelet abnormality
- idiopathic thrombocytopenic purpura (ITP), secondary thrombocytopenia
- leukaemia
- other infiltrates
- Gram negative sepsis
- aplastic anaemia
ecchymoses
- abnormal coagulation
- haemophilia A & B
- von-Willebrand disease
- Christmas disease
site
- hemarthroses – haemophilia
- splenomegaly etc.
- lymphadenopathy
- hepatomegaly
- anaemia
- others – bleeding with:
- eczema: Wiskott-Aldrich syndrome
- telangiectasia: hereditary haemorrhagic telangiectasia (Osler–Weber–Rendu syndrome)
- hyper-elastic skin: Ehlers-Danlos syndrome
