Hiram-Karasmanis Rania, Smith Ronald Garth, Radina Maria, Soboleski Donald Allen
Department of Pediatrics, Queen's University, Kingston, ON, Canada.
J Med Case Rep. 2010 Mar 29;4:98. doi: 10.1186/1752-1947-4-98.
Henoch-Schönlein purpura is a common immunoglobulin A-mediated vasculitic syndrome in children, characterized by purpuric rash, arthritis and abdominal pain. Renal involvement, manifested by the presence of hematuria and/or proteinuria, is also frequently seen. In most cases, patients with this disease achieve complete recovery, but some progress to renal impairment. Gastro-intestinal manifestations are present in two-thirds of affected patients and range from vomiting, diarrhea, and peri-umbilical pain to serious complications such as intussusception and gastrointestinal hemorrhage.
We report the case of a 7-year-old Caucasian girl who presented with abdominal pain, labial swelling, and a large abdominal ecchymosis two weeks after having been diagnosed with Henoch-Schönlein purpura. A computed tomography scan revealed abdominal wall edema extending to the groin, without any intra-abdominal pathology. She was successfully treated with intravenous steroids.
Circumferential anterior abdominal wall edema and labial edema have never been reported previously, to the best of our knowledge, as a complication of Henoch-Schönlein purpura. These findings further contribute to the wide spectrum of manifestations of this disorder in the literature, aiding in its recognition and management.
过敏性紫癜是儿童常见的免疫球蛋白A介导的血管炎综合征,其特征为紫癜性皮疹、关节炎和腹痛。血尿和/或蛋白尿所表现出的肾脏受累情况也较为常见。在大多数情况下,该疾病患者可完全康复,但部分患者会进展为肾功能损害。三分之二的受累患者存在胃肠道表现,范围从呕吐、腹泻、脐周疼痛到诸如肠套叠和胃肠道出血等严重并发症。
我们报告一例7岁白人女孩的病例,该女孩在被诊断为过敏性紫癜两周后出现腹痛、唇部肿胀和大面积腹部瘀斑。计算机断层扫描显示腹壁水肿延伸至腹股沟,无任何腹腔内病变。她通过静脉注射类固醇成功治愈。
据我们所知,此前从未有过关于过敏性紫癜并发症出现腹壁环形前水肿和唇部水肿的报道。这些发现进一步丰富了该疾病在文献中的广泛表现谱,有助于对其进行识别和处理。