Henochschonlein purpura american academy of pediatrics. The primary morphologies of purpura include petechiae, macular. These tests will assess the patients nutrition, platelet levels, inflammation. Subscribe this medical videos channel for more videos. Nonpalpable purpura results from bleeding into the skin without. Is called haemorrhagic vasculitis or anca negative vasculitis small vessel vasculitis involving vessels of microcirculation which are venules, capillaries and small arteries and characterised by palpable purpura.
It is characterized by a triad of palpable purpura without thrombocytopenia, abdominal pain, and arthritis. Most notable was the purpura on the tip of the nose. No use in setting forth the facts, the palpable right and wrong. Skin manifestations of hsp are characteristic and include a nonthrombocytopenic palpable purpura of the lower extremities and buttocks. En atencion primaria ap, debe sospecharse una plaquetopenia ante una purpura no palpable y una vasculitis leucocitoclastica ante una purpura palpable. These spots usually are felt on the fingertips and for this reason, they are commonly known as palpable purpura. Dyscrasia and vasculitis, two common causes of purpuric eruption were ruled out by laboratory findings as well as by histopathological and direct immunofluorescence exams. Treatments for palpable purpura including drugs, prescription medications, alternative treatments, surgery, and lifestyle changes. Palpable purpura results from inflammatory damage to cutaneous blood vessels. Petechia, purpura, and vasculitis flashcards quizlet. Appropriate evaluation of patients with palpable purpura should always. To determine the cause, doctors must run a range of tests. Henochschonlein purpura hsp rash not always first followed by abdominal symptoms and arthralgia palpable purpura in pressuredependent areas dx.
Aaf presents with a 3 day history of painful purpura initially on her bilateral lower extremities, now with smaller lesions on her nose, arms, and ears. Underlying cancer, drug exposures, or no inciting event is often found. Not sick no systemic symptoms nonpalpable purpurascurvysenile purpura. A multidisciplinary approach to the management of severe. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. The content on this site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. Clinical no thrombocytopenia, normal ptptt skin bx. A case of hsp is reported in a 36yearold female with ten days history of multiple palpable purpura on region antebrachii. Henochschonlein purpura symptoms and causes mayo clinic.
She has torpid evolution, and gastrointestinal and renal complications. Jul 20, 2018 purplish red spots on the lower extremities are a common sign of vasculitis. Henochschonlein purpura hsp is a small vessel vasculitis that annually affects 10 to 20 children per 100,000 population. Palpable purpura and a visible sock line mdedge family medicine. Skin rash in cases of vasculitis as red spots results from the spillage of. The classic symptom of hsp is a red to dark purple rash, called purpura, which is often most severe on the legs and buttocks. A previously healthy, 38yearold man presented with nonpruritic rash over his legs and trunk noticed 2 hours back.
Examination revealed nonpalpable purpura over the limbs and trunk. Paciente con purpura cutanea monica rodriguez carballeira. Other symptoms include painful swelling around the joints and abdominal pain. Palpable petechiae and purpura are a result of either perivascular inflammation vasculitis or infection. For most people, symptoms improve within a month, leaving no lasting problems. The primary morphologies of purpura include petechiae, macular purpura, palpable. Palpable purpura is purpura than can be felt, due to inflammation of the blood vessels vasculitis. Although older individuals have other comorbidities that may readily explain end organ damage, the presence of palpable purpura should elicit a prompt dermatology consult with biopsy for suspected vasculitis. Okay, so at least like 5 years, i have been getting spots on the tops of my hands or fingers mostly fingers. The patient had palpable purpura on her lower extremities.
Vasculitis 3 classification of vasculitis smallsized vesselscont. Palpable purpura is a condition where purpura, which constitutes visible nonblanching hemorrhages, are raised and able to be touched or felt upon palpation. Aug 01, 2001 evaluating the child with purpura this is a corrected version of the article that appeared in print. Pigmented lesions are usually brown in color in comparison to the violaceous color of purpuric lesions. It is characterized by palpable nonthrombocytopenic purpura over the lower extremities, arthritis, abdominal pain with or without gastrointestinal hemorrhage, and, less commonly, intussusception and glomerulonephritis. Palpable purpura hsp henoch schonlein purpura youtube.
Purpura no palpable dermatosis purpuricas pigmentarias. Protocolo diagnostico del paciente con purpura no trombopenica. Three weeks prior she was treated at an urgent care clinic with oral clindamycin for a recurrent staphylococcus infection of her finger. Oct 05, 2019 her voice, her palpable agitation, prepared us for something extraordinary.
A 72yearold white man was admitted for worsening palpable purpura over a twoday period. By dipstick, the patient had blood in her urine but no protein. Henochschonlein purpura, who presented to our department with cutaneous manifestations. Purpura not due to a low platelet count, caused by inflammation in blood vessels of the skin, is the hallmark of hsp. Palpable purpura can evolve into nodular, vesicular, pustular, necrotic, or ulcerative lesions. We present a case series of patients with severe purpura fulminans who were managed via a multidisciplinary approach at a regional burn center. Leukocytoclastic vasculitis, which is manifested as palpable purpura fig. In cutaneous vasculitis, there is frequently purpura or ulceration.
Henochschonlein purpura cryoglobulinemia hypocomplementemic urticarial vasculitis vasculitis associated with sle, rhuematoid arthritis, or other autoimmune diseases serumsickness or druginduced vasculitis classification of vasculitis. Diagnostic evaluation high clinical suspicion iga deposition noted on immunofluorescence microscopy of the skin lesion biopsy, complete blood count with differential cytopenia may suggest underlying connective tissue disease leukocytosis can suggest infection or hematologic. Despite this association, no single microorganism or environmental exposure has been confirmed as an important cause of hsp. Adults may present with any two of the four criteria in the tetrad 87% sensitivity and specificity. Although hsp is seen in infancy through adulthood, most documented cases affect children. Feb 12, 2014 in this case report, we reported for the first time a rare case of hstl whose clinical presentation was a petechial non palpable purpura of the face. Non palpable petechiae usually occur in low platelet states such as itp and dic rash red flags 1. Closeup of palpable purpura, looking like a target. Hsp is an autoimmune disorder that manifests as purplish rashes especially in legs and buttocks. Diagnosis and treatment of cutaneous leukocytoclastic vasculitis. Hsp is a childhood inflammatory disease that affects the small blood vessels.
Henoch schonlein purpura anaphylactoid purpura, hsp ncbi. Nonthrombocytopenic purpura an overview sciencedirect. Skin rash in cases of vasculitis as red spots results from the spillage of blood from the inflamed blood vessels into the skin. Henochschonlein purpura is a small vessel vasculitis that affects mainly pediatric patients, characterized by the tetrad of palpable purpura, abdominal pain, arthralgia or arthritis. In the skin, the disease causes palpable purpura small, raised areas of bleeding underneath the skin, often with joint pain and abdominal pain. Two days prior to admission, metoclopramide 10 mg orally three times per day was started for a gastrointestinal condition. Raised, palpable discoloration of skin or mucous membrane due to vascular inflammation in the skin and extravasation of blood petechiae, ecchymosis, and palpable purpura do not blanch because blood has leaked outside the vessels into the surrounding skin. The approach outlined within is focused on the identification of the primary cutaneous morphology from which one can then generate a focused differential diagnosis and initiate an appropriate workup. Palpable purpura results from blood vessel inflammation vasculitis due to immunemediated vessel injury thrombosis and immune complex deposition in vessel walls leading to fibrinoid necrosis. In fact, i have noticed when i hit my hand really hard i have remembered to look for the bruise, and i dont get any bruise then. Evaluating the child with purpura american family physician.
They are purpuric due to the leakage of blood through the vessel wall into the surrounding tissue. To report a case of reversible nonthrombocytopenic palpable purpura associated with metoclopramide. Classical hsp includes a tetrad of palpable purpura, arthritis, abdominal pain, and glomerulonephritis. He had mild pallor and direct ophthalmoscopy showed bilateral fundal haemorrhage with sparing of macula. Purpura is the name given to the discolouration of the skin or mucous membranes due to haemorrhage from small blood vessels.
Noninflammatory vessel wall abnormalities nonpalpable purpura disorders of collagen production and increased capillary fragility. Purpura definition of purpura by medical dictionary. Updates in the approach to the patient with purpura. Mar 01, 2017 purpura itself is a symptom rather than a condition. When accompanied by a decrease in the circulating platelets, it is. Painful purpura and cutaneous necrosis mdedge dermatology. Reversible nonthrombocytopenic palpable purpura associated.
Palpable purpura classically is associated with leukocytoclastic vasculitis, an inflammatory process that injures the vessel. Aug 25, 2019 purpura fulminans is a lifethreatening hematological emergency characterized by skin necrosis and disseminated intravascular coagulation requiring rapid diagnosis and treatment. Her voice, her palpable agitation, prepared us for something extraordinary 1916, kathleen norris, the heart of rachael, chapter 7. Purpura can be differentiated from pigmented lesions by color. Henochschonlein purpura hsp, also known as iga vasculitis, is a disease of the skin, mucous membranes, and sometimes other organs that most commonly affects children. A case of painful palpable purpura richard oneal, md ghs dept of internal medicine, pgy2. Jul 24, 2019 henochschonlein purpura is slightly more common in males than in females. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease. Ecchymoses or bruises are larger extravasations of blood. The lesions are elevated palpable due to the inflammationedema from vessel wall damage. Vasculitis 39 clinical manifestations abdominal pain purpura of the small bowel, i. Purpura classificationcauses sick systemic symptoms nonpalpable purpurarocky mountain spotted fever. Learn vocabulary, terms, and more with flashcards, games, and other study tools.
Petechiae, ecchymoses, and palpable purpura do not blanch because blood has leaked outside the vessels into the surrounding skin. A 44yearold woman with a history of hepatitis c virus and cocaine abuse presented with painful bruising and skin breakdown. In the skin, the disease causes palpable purpura small, raised areas of bleeding. A case of painful palpable purpura health sciences center. There was multiple wet purpura over the buccal mucosa, palate and tongue figure 1a. Purplish red spots on the lower extremities are a common sign of vasculitis.
Purpura itself is a symptom rather than a condition. White and asian children are more likely to develop henochschonlein purpura than are black children. It indicates some sort of vasculitis secondary to a serious disease. Palpable purpura is due to inflammatory damage to the blood vessel, which is known as vasculitis. One week later she started developing purpura and painful skin necrosis and ulceration.
390 315 1417 1082 329 1447 1173 426 1044 223 544 849 1197 1111 1254 1398 877 215 224 1029 529 469 562 146 206 1130 1244 621 1218 1048 1059 1192 153 734 1222 1335 123 175 279 752 710 1203 73 859 290