Quiz: How would you manage this child’s purpuric lesions?

This three-year-old girl presents to her paediatrician with a one-week history of abdominal pain and a rash.

Her mother mentions that the rash developed following recovery from a URTI and that she has also been complaining of knee pain.

On examination, a purpuric rash is seen on her legs and feet. Urinalysis reveals haematuria and proteinuria.

Which of the following is most likely to be associated with this patient’s condition?

  • Hyperthyroidism
  • Hearing loss
  • Intussusception
  • Coronary artery dilation

You can check your answer under the image.

Image credit:@pamjumps

Answer: Intussusception

This patient’s findings are suggestive of Henoch-Schönlein purpura (HSP): the most common paediatric vasculitis, involving the small vessels of the skin, gastrointestinal tract, kidneys and joints.

The self-limiting condition is characterised by the classic clinical triad of purpura, abdominal pain and arthritis.

Intussusception is a complication of the condition and the most common surgical indication, occurring in approximately 3% of HSP patients.

Acute or progressive abdominal findings should signal clinicians to investigate accordingly.

You can see more cases like this at Figure1.