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PEDIATRICS

SYMPTOMS/EXAM

■ Rash: Palpable purpura, usually starting on lower extremities and progress-

ing toward the torso (see Figure 5.19)

■ Crampy abdominal pain

■ Arthritis, usually periarticular and most often affecting the knees

■ Hematuria

■ Additional symptoms can include: Nonpitting edema of the extremities and

face, melena, hematemesis, fever, hepatomegaly, headache, seizures

DIFFERENTIAL

■ Abdominal pain can mimic acute appendicitis.

■ Rash: Consider meningococcal sepsis, bleeding disorder or drug reaction.

■ Arthritis: JRA or SLE

DIAGNOSIS

■ Lab tests supporting the diagnosis of HSP include

■ Elevated WBC

■ Anemia

■ Elevated ESR

■ Hematuria

■ Abdominal CT may reveal the “thumbprinting” of submucosal hemorrhage.

FIGURE 5.19. Henoch-Schönlein purpura. (See also color insert.)

(Reproduced, with permission, from Shah BR, Lucchesi M. Atlas of Pediatric Emergency

Medicine. New York: McGraw-Hill, 2006:109.)