Guo Hui, Wang Zhi-Ling, Tao Zhu
Department of Pediatrics, West China Second University Hospital, Chengdu 610041, Sichuan Province, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu 610000, Sichuan Province, China.
World J Clin Cases. 2023 Sep 16;11(26):6311-6317. doi: 10.12998/wjcc.v11.i26.6311.
For children with abdominal Henoch-Schonlein purpura presenting abdominal pain as an initial symptom and severe clinical manifestations, but without purpura appearance on the skin, the diagnosis and treatment are relatively difficult. This study summarized the characteristics of this group of patients by literature review and provided additional references for further refinement of glucocorticoid therapy in this vasculitis.
A 6-year-old girl presented mainly with repeated abdominal pain and had received short-term out-of-hospital treatment with hydrocortisone. On day 7 after onset, gastroscopy revealed chronic non-atrophic gastritis and erosive duodenitis without purpuric rash, and no obvious resolution of the abdominal pain was found after treatment against infection and for protection of gastric mucosa. On day 14 the inflammatory indices continued to rise and the pain was relieved after enhanced anti-infective therapy, but without complete resolution. On day 19, the patient presented with aggravated abdominal pain with purplish-red dots on the lower limbs, by which Henoch-Schonlein purpura was confirmed. After 5 d of sequential treatment with methylprednisolone and prednisone, abdominal pain disappeared and she was discharged.
Henoch-Schonlein purpura-related rash may appear after long-term abdominal pain, and should be distinguished from acute and chronic gastrointestinal diseases at the early stage without typical rash. For bacterial infection-induced Henoch-Schonlein purpura, glucocorticoid therapy alone without clearing the infection may not relieve symptoms.
对于以腹痛为首发症状且临床表现严重，但皮肤无紫癜表现的腹型过敏性紫癜患儿，诊断及治疗相对困难。本研究通过文献复习总结该组患者的特点，为进一步优化该血管炎的糖皮质激素治疗提供参考。
一名6岁女童主要表现为反复腹痛，曾在院外接受氢化可的松短期治疗。发病第7天，胃镜检查显示慢性非萎缩性胃炎和糜烂性十二指肠球炎，无紫癜皮疹，抗感染及保护胃黏膜治疗后腹痛无明显缓解。第14天炎症指标持续升高，强化抗感染治疗后疼痛缓解，但未完全缓解。第19天，患者腹痛加重，双下肢出现紫红色斑点，确诊为过敏性紫癜。经甲泼尼龙及泼尼松序贯治疗5天后，腹痛消失，患儿出院。
过敏性紫癜相关皮疹可能在长期腹痛后出现，早期无典型皮疹时应与急慢性胃肠道疾病相鉴别。对于细菌感染诱发的过敏性紫癜，单纯使用糖皮质激素而不清创感染可能无法缓解症状。
