KL Hon, JK Shum, J Li, P Choi, EA Nelson, AK Leung

Abstract

Henoch-Schönlein purpura (HSP) is a common childhood vasculitis. Despite its first description in the 1800s, aetiology remains unclear. Initial intestinal symptomatology may be severe and mislead the underlying vasculitic process. HSP may have delayed development of rash which makes the diagnosis challenging. We describe two cases of HSP with prominent initial abdominal symptomatology, and one case with refusal to walk to illustrate the protean features. In the first case, the gastrointestinal symptoms subsided rapidly with the onset of florid dermatological manifestations, whereas the second case presented as acute gastrointestinal emergency. The third case had more severe limb pain and relatively mild abdominal symptoms. A high index of suspicion with prompt diagnosis is pivotal to avoid unnecessary treatment such as antibiotics, corticosteroid or surgery for this systemic disease with cutaneous manifestations. We address clinical questions on the usage of empirical antibiotics and corticosteroids by performing literature search. Unlike other vasculitis, literature review suggests that a definite bacterial agent is usually not associated with HSP and corticosteroid is only indicated with severe renal involvement.