1. Anaphylactoid purpura
-Vasculitis of small vessels
Henoch Schonlein Purpura
CSN Vittal

2. HSP
 Typically follows an attack of URI
 More frequent in children (2-8 yrs)
 Most frequently in winter months
 Males twice as frequently as females
 Incidence 9/100,000 population
CSN Vittal

3. Pathogenesis
 IgA mediated vasculitis of small vessels
 Deposition of IgA & C3 in small vessels of skin
and renal glomeruli
 ASO titers increase - ? Group A streptococcus
CSN Vittal

4. Clinical
 Acute
 Insidious
 Rash – palpable purpura
 Red – purple – rusty brown – fade
 Lesions in crops – last from 3-10 days
 Intervals vary from 3-4 months
 Local angioedema in dependent or distensible areas
 Arthritis in 2/3 knees, ankles
 Serous effusions – resolve without residual damage
CSN Vittal

5. Clinical
 Edema and damage to vasculature of GI tract
leads to pain abdomen – often colicky
 Occult heme – positive stools, diarrhoea with
or without visible blood or hematemesis
 Intessusception with current jelly stools may
occur (ileo-ileal)
 Renal involvement in 25-50%
 HSM, lymphadenopathy
CSN Vittal

6. Complications
 Rarely CNS involvement
 Seizures, peresis. Coma
 Rheumatoid like nodules
 Cardiac and eye involvement
 Pancreatitis
 Pulmonary or intramuscular hemorrhages
CSN Vittal

7. Diagnosis
 Palpable purpura
 Crops in dependant areas
DD:
 Kawasaki disease
 Polyarteritis nodosa
 Meningococcemia
 Systemic JRA
 Factor V Leiden / Protein C deficiency
CSN Vittal

8. Labs
 Normal
 Biopsy : confirmatory [cutaneous vasculitis]
CSN Vittal

9. Treatment
 Symptomatic
 Hydration
 Pain control
 Avoidance of competitive activities
 GI symptoms ; IV Corticosteroids :
 1-2 mg/kg/hr
CSN Vittal

10. Complications
 Renal involvement : Nephrotic syndrome
 Bowel perforation
 Testicular torsion
CSN Vittal

11. Prognosis
 Self limiting
 < 1% develop renal involvement and , 0.1%
develop serious renal disease
 Rarely death in acute stage due to bowel
infarction
CSN Vittal