154 Henoch–Schönlein purpura Instruction Look at this patient’s legs. Salient features History • Ask the patient about the following: • Upper respiratory tract infection • Joint pains (knees and ankles are commonly involved) • Abdominal pain • The rash: its onset and evolution • Recent drug ingestion. Examination • Purpuric rash over the legs (Fig. 154.1) and buttocks. Fig. 154.1 Henoch–Schönlein purpura: palpable purpuric lesions. Remember: Palpable purpura implies an inflammatory process, most classically cutaneous small cell vasculitis. Proceed as follows: • Tell the examiner that you would like to examine the rest of the body—including arms, body, scalp and behind the ears—for distribution of rash. • Examine the mouth to confirm or rule out involvement of mucous membranes. • Tell the examiner that you would like to examine the urine for haematuria. Diagnosis This patient has purpuric rash over the legs and buttocks with renal involvement (lesions) caused by Henoch-Schönlein purpura (aetiology). I would like to know his 24-h urine output and levels of urea and electrolytes to determine renal function (functional status). Advanced-level questions What do you know about Henoch–Schönlein purpura? Henoch–Schönlein or anaphylactoid purpura is a distinct, self-limiting vasculitis that occurs in children and young adults, with a peak incidence in the first two decades of life. It is a disorder characterized by non-thrombocytopenic purpura, arthralgia, abdominal pain and glomerular nephritis. It is the result of circulating immunoglobulin (Ig) A-containing immune complexes. It usually lasts between 1 and 6 weeks and subsides without sequelae if renal involvement is mild. The presence of IgG indicates a worse prognosis. Adults are more likely to develop renal involvement (Lancet 1992;339:280). In biopsy specimens obtained from the skin of patients with Schönlein–Henoch purpura, the dermal vessels frequently contain IgA deposits. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Like this:Like Loading... Related Related posts: Permanent cardiac pacemaker/implantable cardioverter-defibrillator Cauda equina syndrome Dermatomyositis Arteriovenous fistula Stay updated, free articles. Join our Telegram channel Join Tags: 250 Cases in Clinical Medicine Dec 4, 2016 | Posted by admin in GENERAL & FAMILY MEDICINE | Comments Off on Henoch–Schönlein purpura Full access? Get Clinical Tree
154 Henoch–Schönlein purpura Instruction Look at this patient’s legs. Salient features History • Ask the patient about the following: • Upper respiratory tract infection • Joint pains (knees and ankles are commonly involved) • Abdominal pain • The rash: its onset and evolution • Recent drug ingestion. Examination • Purpuric rash over the legs (Fig. 154.1) and buttocks. Fig. 154.1 Henoch–Schönlein purpura: palpable purpuric lesions. Remember: Palpable purpura implies an inflammatory process, most classically cutaneous small cell vasculitis. Proceed as follows: • Tell the examiner that you would like to examine the rest of the body—including arms, body, scalp and behind the ears—for distribution of rash. • Examine the mouth to confirm or rule out involvement of mucous membranes. • Tell the examiner that you would like to examine the urine for haematuria. Diagnosis This patient has purpuric rash over the legs and buttocks with renal involvement (lesions) caused by Henoch-Schönlein purpura (aetiology). I would like to know his 24-h urine output and levels of urea and electrolytes to determine renal function (functional status). Advanced-level questions What do you know about Henoch–Schönlein purpura? Henoch–Schönlein or anaphylactoid purpura is a distinct, self-limiting vasculitis that occurs in children and young adults, with a peak incidence in the first two decades of life. It is a disorder characterized by non-thrombocytopenic purpura, arthralgia, abdominal pain and glomerular nephritis. It is the result of circulating immunoglobulin (Ig) A-containing immune complexes. It usually lasts between 1 and 6 weeks and subsides without sequelae if renal involvement is mild. The presence of IgG indicates a worse prognosis. Adults are more likely to develop renal involvement (Lancet 1992;339:280). In biopsy specimens obtained from the skin of patients with Schönlein–Henoch purpura, the dermal vessels frequently contain IgA deposits. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Like this:Like Loading... Related Related posts: Permanent cardiac pacemaker/implantable cardioverter-defibrillator Cauda equina syndrome Dermatomyositis Arteriovenous fistula Stay updated, free articles. Join our Telegram channel Join Tags: 250 Cases in Clinical Medicine Dec 4, 2016 | Posted by admin in GENERAL & FAMILY MEDICINE | Comments Off on Henoch–Schönlein purpura Full access? Get Clinical Tree
