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Henoch–Schönlein Purpura, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

Vasculitis 

Etiology

Mechanism: 
  • Increased serum IgA:

    • Circulating IgA complexes

    • Glomerular mesangial deposition of IgA

  • Although cause is undefined, there are many associated conditions:

    • Inf...

Diagnosis

Signs and Symptoms

  • General:

    • Well-appearing child, despite nature and extent of rash

    • Recent or current upper respiratory tract infection

    • Malaise

    • Low-grade fever

    • Hypertension, if associated renal fa...

Treatment

Pre-Hospital

Stabilize as clinically indicated 

Initial Stabilization/Therapy

  • IV fluids for shock

  • Packed RBCs for massive GI hemorrhage

Ed Treatment/Procedures

  • Emergent intervention for life-threa...

Follow-Up

Disposition

Admission Criteria

  • Severe abdominal pain

  • CNS findings

  • GI bleeding

  • Intussusception

  • Evidence of renal failure

Discharge Criteria

  • Normal platelet count

  • Normal renal function

  • Minimal or no abd...

Pearls and Pitfalls

  • Exclude life-threatening causes

  • NSAIDs are usually adequate

  • Most patients do not require systemic corticosteroids as it has not been shown to affect the prognosis of HSP nephritis

Additional Reading

  • Chang  WL, Yang  YH, Wang  LC, et al. Renal manifestations in Henoch-Schonlein purpura: A 10-year clinical study. Pediatr Nephrol.  2005;20:1269–1272.

  • Chartapisak  W, Opastiraku...

Codes

ICD9

287.0 Allergic purpura 

ICD10

D69.0 Allergic purpura 

SNOMED

  • 191306005 Henoch-Schonlein purpura (disorder)

  • 239946005 Postinfective Henoch-Schönlein purpura

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