Review Question - QID 100584

A rash in the setting of colicky abdominal pain and polyarthralgia suggest Henoch-Schonlein purpura (HSP). The course of the disease is usually self-limited but glomerulonephritis and potentially ESRD are long-term complications in some patients.

HSP is a small vessel, leukocytoclastic angiitis associated with IgA and C3 deposition. It presents in children (ages 3-11) with colicky abdominal pain, a typical dependent purpuric rash on the lower extremities, and polyarthralgia, often in the large joints of the lower extremities. It is often related to recent infection. Diagnosis is based on clinical criteria from the American College of Rheumatology. If uncertainty exists, a skin biopsy demonstrating leukocystoclastic vasculitis with IgA deposits is conclusive. Treatment is supportive as the disease is usually self-limited though controversy about use of steroids exists.

FIgure A shows the dependent purpuric rash covering the lower extremities that is characteristic of HSP.

Incorrect Answers:
Answer 1: Septic shock may rapidly result from meningococcemia, a possible cause of purpura in young children that is less likely given the distribution of this patient's rash and concordant abdominal pain.
Answer 3: Congenital rubella may cause a purpuric, "blueberry-muffin" rash in neonates and may also cause deafness.
Answer 4: Rheumatic fever results from untreated Group A streptococcal infection. GAS infections may cause cellulitis, erysipelas or impetigo, but do not typically cause a purpuric rash like the one seen in Figure A.
Answer 5: Aortic regurgitation is another complication from rheumatic heart disease.