eMedicine Specialties > Emergency Medicine > Hematology & Oncology

Henoch-Schonlein Purpura: Differential Diagnoses & Workup

Author: Philip Bossart, MD, Professor, Department of Surgery, Division of Emergency Medicine, University of Utah Hospital, University of Utah School of Medicine
Contributor Information and Disclosures

Updated: Jun 18, 2009

Differential Diagnoses

Disseminated Intravascular Coagulation
Endocarditis
Pancreatitis
Pediatrics, Meningitis and Encephalitis
Testicular Torsion
Thrombocytopenic Purpura

Other Problems to Be Considered

Essential mixed cryoglobulinemia
Waldenström macroglobulinemia
Systemic lupus erythematosus
Rickettsial diseases
Bowel infarction/perforation

Workup

Laboratory Studies

  • Diagnosis of Henoch-Schönlein purpura is clinical and not based on laboratory evaluation. Routine laboratory test results are usually within reference ranges.
  • Some laboratory studies help in excluding other diagnoses and in evaluating renal function, including urinalysis, CBC with platelet count and differential, BUN level, creatinine level, prothrombin time (PT), activated partial thromboplastin time (aPTT), and lipase level.
  • Urinalysis: Hematuria and/or proteinuria are present in 10-20% of patients.
  • Platelet count and coagulation studies: Platelet count is usually in the reference range but may be elevated; the platelet count should not be low in Henoch-Schönlein purpura. A normal platelet count rules out idiopathic thrombocytopenic purpura (ITP). A normal platelet count and normal coagulation studies (ie, PT, aPTT, fibrin split products) rule out thrombotic thrombocytopenic purpura (TTP).
  • Lipase: A normal lipase level makes acute pancreatitis very unlikely.
  • CBC and differential: WBC count may be in the reference range or elevated. Eosinophilia is sometimes present.
  • Erythrocyte sedimentation rate: Sedimentation rate may be in the reference range or elevated.
  • BUN and creatinine levels: These may be elevated from renal involvement of Henoch-Schönlein purpura (HSP) or from dehydration.

Imaging Studies

  • Abdominal ultrasonography may be better than barium enema to diagnose intussusception, since Henoch-Schönlein purpura (HSP)–related intussusception is more often ileoileal instead of ileocolic as is typical in idiopathic intussusception.
  • Doppler or radionuclide testicular scan results show normal or increased blood flow in Henoch-Schönlein purpura, in contrast to the decreased blood flow seen in testicular torsion.

More on Henoch-Schonlein Purpura

Overview: Henoch-Schonlein Purpura
Differential Diagnoses & Workup: Henoch-Schonlein Purpura
Treatment & Medication: Henoch-Schonlein Purpura
Follow-up: Henoch-Schonlein Purpura
Multimedia: Henoch-Schonlein Purpura
References
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References

  1. Blanco R, Martinez-Taboada VM, Rodriguez-Valverde V, Garcia-Fuentes M, Gonzalez-Gay MA. Henoch-Schonlein purpura in adulthood and childhood: two different expressions of the same syndrome. Arthritis Rheum. May 1997;40(5):859-64. [Medline].

  2. Szer IS. Henoch-Schonlein purpura. Curr Opin Rheumatol. Jan 1994;6(1):25-31. [Medline].

  3. Gedalia A. Henoch-Schönlein purpura. Curr Rheumatol Rep. Jun 2004;6(3):195-202. [Medline].

  4. Pillebout E, Thervet E, Hill G, Alberti C, Vanhille P, Nochy D. Henoch-Schonlein Purpura in adults: outcome and prognostic factors. J Am Soc Nephrol. May 2002;13(5):1271-8. [Medline].

  5. O'Brien WM, O'Connor KP, Horan JJ, Eggli DF, Gibbons MD. Acute scrotal swelling in Henoch-Schonlein syndrome: evaluation with testicular scanning. Urology. Apr 1993;41(4):366-8. [Medline].

  6. [Best Evidence] Chartapisak W, Opastiraku S, Willis NS, Craig JC, Hodson EM. Prevention and treatment of renal disease in Henoch-Schönlein purpura: a systematic review. Arch Dis Child. Feb 2009;94(2):132-7. [Medline].

  7. Saulsbury FT. Clinical update: Henoch-Schönlein purpura. Lancet. Mar 24 2007;369(9566):976-8. [Medline].

  8. Huber AM, King J, McLaine P, Klassen T, Pothos M. A randomized, placebo-controlled trial of prednisone in early Henoch Schönlein Purpura [ISRCTN85109383]. BMC Med. Apr 2 2004;2:7. [Medline].

  9. [Best Evidence] Ronkainen J, Koskimies O, Ala-Houhala M, et al. Early prednisone therapy in Henoch-Schonlein purpura: a randomized, double-blind, placebo-controlled trial. J Pediatr. Aug 2006;149(2):241-7. [Medline].

  10. Flynn JT, Smoyer WE, Bunchman TE, Kershaw DB, Sedman AB. Treatment of Henoch-Schönlein Purpura glomerulonephritis in children with high-dose corticosteroids plus oral cyclophosphamide. Am J Nephrol. Mar-Apr 2001;21(2):128-33. [Medline].

  11. Szer IS. Henoch-Schonlein purpura: when and how to treat. J Rheumatol. Sep 1996;23(9):1661-5. [Medline].

  12. [Best Evidence] Weiss PF, Feinstein JA, Luan X, Burnham JM, Feudtner C. Effects of corticosteroid on Henoch-Schönlein purpura: a systematic review. Pediatrics. Nov 2007;120(5):1079-87. [Medline].

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Further Reading

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Keywords

Henoch-Schonlein purpura, Henoch-Schönlein purpura, HSP, symptoms, treatment, vasculitis, small-vessel vasculitis, purpura, arthritis, skin rash, spots, abdominal pain, hematuria, nonthrombocytopenic purpura, purpura rheumatica, upper respiratory illness, URI, HSP nephritis, immunoglobulin A nephropathy, IgA nephropathy, rash, subcutaneous edema, scrotal edema, palpable purpura, HSP-related intussusception, idiopathic thrombocytopenic purpura, ITP, thrombotic thrombocytopenic purpura, TTP

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Contributor Information and Disclosures

Author

Philip Bossart, MD, Professor, Department of Surgery, Division of Emergency Medicine, University of Utah Hospital, University of Utah School of Medicine
Philip Bossart, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

Edmond A Hooker II, MD, DrPH, FAAEM, Assistant Professor, Department of Health Services Administration, Xavier University; Associate Clinical Professor, Department of Emergency Medicine, University of Louisville; Assistant Clinical Professor, Department of Emergency Medicine, Wright State University
Edmond A Hooker II, MD, DrPH, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Public Health Association, Society for Academic Emergency Medicine, and Southern Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Jeffrey L Arnold, MD, FACEP, Chairman, Department of Emergency Medicine, Santa Clara Valley Medical Center
Jeffrey L Arnold, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physicians
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Steven C Dronen, MD, FAAEM, Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier Medical Center
Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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