Will Henoch-Schonlein Purpura Recur?

When it comes to Henoch-Schönlein purpura, people may be unfamiliar with it. Henoch-Schonlein purpura is actually a type of vasculitis, which is seen in bleeding in small blood vessels and capillaries. It may be caused by infection with pathogens, drug effects or allergies. Henoch-Schonlein purpura manifests as purpura and abdominal pain, but the platelet count will not be reduced during examination. Henoch-Schonlein purpura is more common in children, so will Henoch-Schonlein purpura recur?

Henoch-Schonlein purpura, also known as self-limiting acute hemorrhagic disease, is an allergic vasculitis that invades the small arteries and capillaries of the skin and other organs. The cause of the disease may be infection by pathogens, the effects of certain drugs, allergies, etc., which lead to the formation of IgA or IgG circulating immune complexes in the body, which are deposited in the capillaries in the upper dermis and cause vasculitis. The main manifestations are purpura, abdominal pain, joint pain and renal damage, but thrombocytopenia does not occur. Some people believe that allergic purpura and allergic cutaneous vasculitis belong to the same spectrum of diseases. This disease is the most common type of vasculitis in children. It is more common in school-age children, with the common age of onset being 7 to 14 years old. It is rare in infants under 1 year old.

Clinical manifestations: It is common in children and adolescents, and may initially present with fever, headache, joint pain, and general discomfort.

1. Skin

Most cases present with skin purpura as the first symptom. Skin lesions appear as pinpoint to soybean-sized petechiae, ecchymoses or urticaria-like rashes or pink maculopapular rashes that do not fade when pressed, which is purpura. Purpura may merge into patches and eventually turn brown. It usually disappears within 1 to 2 weeks without leaving any trace. In severe cases, blisters, blood blisters, necrosis and even ulcers may occur. The rash often occurs in weight-bearing areas, especially on the extensor side of the limbs, especially the lower limbs, around the ankle joints and buttocks. The lesions are symmetrically distributed, appear in batches, and are prone to recurrence. Only skin damage is also called simple purpura.

2. Digestive system

About 2/3 of cases present with gastrointestinal symptoms. It usually appears within 1 week of the rash. Common abdominal pain, often manifested as paroxysmal periumbilical pain and colic, abdominal pain may also occur in other parts of the abdomen. There may be tenderness, but rebound tenderness is rare. Accompanied by vomiting. About half of the children have positive fecal occult blood test, some may have bloody stools, or even vomit blood. If abdominal pain occurs before skin symptoms, it is easy to be misdiagnosed as an acute surgical abdomen or even undergo surgical treatment incorrectly. A small number of children may develop complications such as intussusception, intestinal obstruction, intestinal perforation and hemorrhagic enteritis. Patients with abdominal pain, diarrhea, bloody stools, and even gastrointestinal bleeding are also called gastrointestinal purpura.

3. Urinary system

Most cases develop gross hematuria, microscopic hematuria and proteinuria, or tubular urine 2 to 4 weeks after purpura onset. Urinary system symptoms may occur at any time during the course of the disease, and may also appear after the rash subsides or when the disease is dormant. The severity of the disease varies, and severe cases may cause renal failure and hypertension. More than half of the children's kidney damage can be cured clinically on its own. Patients with hematuria, proteinuria and renal damage are also called renal purpura.

4. Joints

Most children only experience swelling, pain, tenderness or arthritis in and around the joints, which may be accompanied by limited mobility. Large joints such as the knees and ankles are most commonly affected, but the wrists, elbows, and fingers may also be affected. Joint lesions are often transient and usually disappear within a few days without leaving joint deformities. Patients with joint swelling, pain, and even joint effusion are called articular purpura.

5. Others

Central nervous system symptoms are rare and include coma, subarachnoid hemorrhage, optic neuritis, and Guillain-Barré syndrome.

Henoch-Schonlein purpura test

1. Hematological examination

Platelet count is normal or elevated. Bleeding time, coagulation time and clot retraction time were all normal. In some children, the total white blood cell count increased to 20.0×109/L, with a left shift in the nucleus. Erythrocyte sedimentation rate may increase.

2. Infection and etiology examination

C-reactive protein is elevated and antistreptolysin may be positive, and β-hemolytic streptococci may be seen in pharyngeal culture.

3. Immunological examination

Antinuclear antibodies and rheumatoid factor are usually negative. About half of the children had elevated serum IgA and IgM levels during the acute phase.

4. Occult blood test

In children with gastrointestinal symptoms such as abdominal pain, stool occult blood may be positive.

5. Urinalysis

Microscopic and gross hematuria may occur when the kidneys are affected. Sometimes severe proteinuria can lead to hypoproteinemia.

6. Imaging examination

For those with gastrointestinal symptoms, abdominal B-mode ultrasound and X-ray examinations can be performed to facilitate early diagnosis of intussusception.

Diagnosis of Henoch-Schonlein Purpura

It is not difficult to diagnose patients with typical symptoms such as purpura on both lower limbs, accompanied by abdominal pain, joint pain or kidney damage. However, when systemic symptoms such as joint pain and abdominal pain appear before skin purpura, it is easy to be misdiagnosed as rheumatoid arthritis or acute abdomen. Clinically, it needs to be differentiated from these diseases and other types of purpura and vasculitis.