Arunath Visvalingam, Athapathu Arjuna Salinda, Hoole Thabitha Jebaseeli, Aruppala Heshan, Rathnasri Asanka, Ranawaka Randula, Mettananda Sachith
University Paediatrics Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.
University Paediatrics Unit, Lady Ridgeway Hospital, Colombo, Sri Lanka.
Case Rep Pediatr. 2020 Sep 14;2020:8823611. doi: 10.1155/2020/8823611. eCollection 2020.
Henoch-Schönlein purpura is a small vessel vasculitis that usually presents with palpable purpura, arthritis, abdominal pain, and nephritis. Subcutaneous oedema of dependent areas is common; however, oedema in the scalp is extremely rare especially in children older than two years. Here, we report a child with massive disfiguring scalp and facial oedema due to Henoch-Schönlein purpura. An eight-year-old boy presented with characteristic palpable purpuric rash and extensive disfiguring scalp and facial swelling for five days. He complained of blurred vision, vomiting, and severe headache on the day of admission. Examination revealed an ill child with extensive oedema of the face and scalp that was tender on palpation. His blood pressure was above the 99 percentile, and he had exaggerated deep tendon reflexes and extensor plantar responses. All biochemical investigations including renal function tests were normal. Noncontrast CT head showed normal brain, with marked soft tissue swelling of the scalp. Ultrasonography showed soft tissue oedema within and surrounding facial muscles without evidence of neck vessel compression. Urine analysis revealed microscopic haematuria on day 14 of the illness, and immunohistochemical staining of renal biopsy confirmed Henoch-Schönlein purpura nephritis. In conclusion, this case report presents a child with severe, disfiguring scalp and facial oedema due to Henoch-Schönlein purpura. It highlights that severe subcutaneous oedema of Henoch-Schönlein purpura can involve any part of the body not limiting to dependent areas.
过敏性紫癜是一种小血管血管炎，通常表现为可触及的紫癜、关节炎、腹痛和肾炎。下垂部位的皮下水肿很常见；然而，头皮水肿极为罕见，尤其是在两岁以上的儿童中。在此，我们报告一例因过敏性紫癜导致头皮和面部严重毁容性水肿的儿童病例。一名8岁男孩出现特征性的可触及紫癜皮疹，并伴有广泛的头皮和面部毁容性肿胀，持续了5天。入院当天，他诉说视力模糊、呕吐和严重头痛。检查发现患儿面部和头皮广泛水肿，触诊时有压痛。他的血压高于第99百分位，且深腱反射亢进，巴氏征阳性。包括肾功能检查在内的所有生化检查均正常。头颅非增强CT显示脑部正常，头皮有明显的软组织肿胀。超声检查显示面部肌肉内及周围有软组织水肿，未见颈部血管受压迹象。发病第14天尿液分析显示镜下血尿，肾活检免疫组化染色证实为过敏性紫癜性肾炎。总之，本病例报告展示了一名因过敏性紫癜导致头皮和面部严重毁容性水肿的儿童。它强调过敏性紫癜严重的皮下水肿可累及身体任何部位，不限于下垂部位。
