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Pediatrics, Henoch-Schonlein Purpura: Differential Diagnoses & Workup

Author: Pamela L Dyne, MD, Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center
Coauthor(s): Stacy Sawtelle, MD, Staff Physician, Department of Emergency Medicine, University of California at Los Angeles/Olive View; Heather Kesler DeVore, MD, Clinical Attending Physician, Assistant Professor Physician, Department of Emergency Medicine, Washington Hospital Center/Georgetown University Hospital
Contributor Information and Disclosures

Updated: Aug 13, 2009

Differential Diagnoses

Arthritis, Rheumatoid
Pediatrics, Hand-Foot-and-Mouth Disease
Disseminated Intravascular Coagulation
Pediatrics, Intussusception
Glomerulonephritis, Acute
Pediatrics, Kawasaki Disease
Idiopathic Thrombocytopenic Purpura
Pediatrics, Meningitis and Encephalitis
Inflammatory Bowel Disease
Renal Failure, Acute
Meningitis
Shock, Septic
Mononucleosis
Systemic Lupus Erythematosus
Orchitis
Testicular Torsion
Pediatrics, Chicken Pox or Varicella
Thrombocytopenic Purpura
Pediatrics, Child Abuse
Tick-Borne Diseases, Rocky Mountain Spotted Fever
Pediatrics, Gastroenteritis
Pediatrics, Gastrointestinal Bleeding

Workup

Laboratory Studies

  • Electrolyte values in patients with Henoch-Schönlein purpura (HSP) are generally in the reference range, but excessive vomiting can affect the values.
  • BUN and creatinine levels may be increased in the presence of renal involvement.
  • Amylase and lipase levels may be elevated in patients with pancreatitis.
  • A CBC count usually reveals a leukocytosis with a left shift, possibly eosinophilia, and a normal or increased platelet count. Hemoglobin and/or hematocrit values may be normal or decreased secondary to bleeding.
  • Urinalysis usually shows hematuria, proteinuria, and occasional red cell casts.
  • Additional laboratory tests that can be helpful in narrowing the differential diagnosis include the following:
    • Assessment of antistreptolysin-O (ASO) titer
    • Monospot test
    • Antinuclear antibody (ANA) test
    • Rheumatoid factor (RF) test
    • Determination of C3/C4 levels
    • Measurement of the prothrombin time (PT)
    • Measurement of the activated partial thromboplastin time (aPTT)
    • Blood cultures

Imaging Studies

  • Imaging studies are necessary only as the clinical picture dictates.
  • CT scanning may aid in the exclusion of other causes of abdominal pain.
  • Barium enema study or endoscopy might be needed to evaluate epigastric pain, hematemesis, and melena.
  • Ultrasonography may be helpful for evaluating intussusception and to exclude appendicitis.
  • A chest radiograph should be obtained after hemoptysis, and a head CT is necessary if neurologic symptoms or severe headache persist.
  • Imaging of the scrotum by means of ultrasonography or a technetium radionuclide scanning may be necessary if scrotal edema is a presenting feature.

More on Pediatrics, Henoch-Schonlein Purpura

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

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

  2. Chang WL, Yang YH, Wang LC, et al. Renal manifestations in Henoch-Schonlein purpura: a 10-year clinical study. Pediatr Nephrol. Sep 2005;20(9):1269-72. [Medline].

  3. Gonzalez-Gay MA, Garcia-Porrua C, Pujol RM. Clinical approach to cutaneous vasculitis. Curr Opin Rheumatol. Jan 2005;17(1):56-61. [Medline].

  4. Lanzkowsky S, Lanzkowsky L, Lanzkowsky P. Henoch-Schoenlein purpura. Pediatr Rev. Apr 1992;13(4):130-7. [Medline].

  5. Martin J, Paco L, Ruiz MP, et al. Inducible nitric oxide synthase polymorphism is associated with susceptibility to Henoch-Schonlein purpura in northwestern Spain. J Rheumatol. Jun 2005;32(6):1081-5. [Medline].

  6. Narchi H. Risk of long term renal impairment and duration of follow up recommended for Henoch-Schonlein purpura with normal or minimal urinary findings: a systematic review. Arch Dis Child. Sep 2005;90(9):916-20. [Medline].

  7. Tapson KM. Henoch-Schonlein purpura. Am Fam Physician. Feb 15 1993;47(3):633-8. [Medline].

  8. Ting TV, Hashkes PJ. Update on childhood vasculitides. Curr Opin Rheumatol. Sep 2004;16(5):560-5. [Medline].

  9. Tintinalli JE, Kelen GD, Stapczynski JS. Henoch Schonlein purpura. In: Emergency Medicine: A Comprehensive Study Guide. 6th ed. 2004:886.

  10. Trujillo H, Gunasekaran TS, Eisenberg GM, et al. Henoch-Schonlein purpura: a diagnosis not to be forgotten. J Fam Pract. Nov 1996;43(5):495-8. [Medline].

  11. Urbach AM, Londino AV. Rheumatology. In: Atlas of Pediatric Physical Diagnosis. 3rd ed. 1997:203-4.

  12. Urbach AM, Londino AV. Dermatology. In: Atlas of Pediatric Physical Diagnosis. 3rd ed. 1997:236-7.

  13. Yigiter M, Bosnali O, Sekmenli T, et al. Multiple and recurrent intestinal perforations: an unusual complication of Henoch-Schonlein purpura. Eur J Pediatr Surg. Apr 2005;15(2):125-7. [Medline].

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Further Reading

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Keywords

Henoch-Schönlein purpura, Henoch-Schonlein purpura, rheumatica purpura, leukocytoclastic vasculitis, allergic vasculitis, HSP, end-stage renal disease, ESRD, intussusception, bowel infarction, bowel perforation, hydrops of the gallbladder, pancreatitis, GI bleeding, chronic renal disease, arthritis, proteinuria, abdominal pain, erythematous macules, urticarial papules, pruritic papules, plaques, measles, yellow fever, cholera, treatment, diagnosis

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Contributor Information and Disclosures

Author

Pamela L Dyne, MD, Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center
Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Stacy Sawtelle, MD, Staff Physician, Department of Emergency Medicine, University of California at Los Angeles/Olive View
Disclosure: Nothing to disclose.

Heather Kesler DeVore, MD, Clinical Attending Physician, Assistant Professor Physician, Department of Emergency Medicine, Washington Hospital Center/Georgetown University Hospital
Heather Kesler DeVore, MD is a member of the following medical societies: Emergency Medicine Residents Association and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Debra Slapper, MD, Consulting Staff, Department of Emergency Medicine, St Anthony's Hospital
Debra Slapper, MD is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Wayne Wolfram, MD, MPH, Clinical Associate Professor, Departments of Pediatrics, Children's Hospital and University of Cincinnati
Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine
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

Richard G Bachur, MD, Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston
Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
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