Case report: Henoch-Schönlein purpura

Abstract

Introduction: Schönlein-Henoch purpura is the most common vasculitis in children,
mediated by immunoglobulin A immune complex storages, which may be preceded by
upper respiratory infections. Objective: to report a case of an atypical cutaneous manifestation, with lesions on the face and upper limbs and absence of lesions on the buttocks, where they are commonly observed. Case description: MDX, 2 years and 2
months old, male, recent previous history of upper respiratory tract infection. The patient
presents abdominal pain, swelling and bilateral palpable purpura located on the lower and upper limbs, as well as erythematous papules on the face. Absence of cutaneous lesions on the buttocks and trunk. Laboratory exams show leukocytosis and thrombocytosis. Histopathologic exam revealed superficial and deep perivascular infiltration with eosinophils, neutrophils and leukocytoclastic vasculitis. Direct immunofluorescence study detected immunoglobulin A deposition within the walls of small vessels. He was admitted to the hospital, receiving only symptomatic treatment. The patient’s condition improved and he was discharged and scheduled for outpatient follow-up. Discussion: the most frequent symptom of Schönlein-Henoch purpura is non-thrombocytopenic palpable purpura that tends to appear in areas such as buttocks and lower limbs. It is a multisystem disease, whit ch affects, besides the skin, mainly intestines, joints and kidneys. This disorder often presents a benign, self-limited and monocyclic course, requiring only symptomatic treatment.