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Case 46 - Henoch–Schönlein purpura

from Section 5 - Gastrointestinal imaging

Published online by Cambridge University Press:  05 June 2014

Kriengkrai Iemsawatdikul
Affiliation:
Siraraj Hospital, Mahidol University
Heike E. Daldrup-Link
Affiliation:
Lucile Packard Children's Hospital, Stanford University
Heike E. Daldrup-Link
Affiliation:
Lucile Packard Children's Hospital, Stanford University
Beverley Newman
Affiliation:
Lucile Packard Children's Hospital, Stanford University
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Summary

Imaging description

A seven-year-old boy presented with nausea and acute, colicky abdominal pain. The medical history revealed a pharyngitis a few weeks ago and the clinical examination demonstrated multiple small purpura (small areas of hemorrhage) of the skin of the buttocks and upper thighs. An upper gastrointestinal (GI) study demonstrated “thumbprinting” of the duodenum (Fig. 46.1). CT images from another patient after oral contrast media administration demonstrate marked mural thickening of a loop of ileum with narrowing of the lumen and some adjacent free fluid (Fig. 46.2).

Importance

Henoch–Schönlein purpura is a disease of young children (50% are younger than six years of age and 90% are younger than 10 years of age), which typically occurs after an upper respiratory tract infection. The infection leads to formation of complexes of IgA and complement component 3, which accumulate in small vessels and cause a small-vessel vasculitis of the skin, joints, GI tract, and sometimes the kidneys. Acute GI symptoms may precede typical cutaneous lesions in 10–15% of patients and may lead to a laparotomy. It is important to recognize typical clinical and imaging findings of this disease, since it usually resolves spontaneously and does not require invasive interventions.

Type
Chapter
Information
Pearls and Pitfalls in Pediatric Imaging
Variants and Other Difficult Diagnoses
, pp. 205 - 206
Publisher: Cambridge University Press
Print publication year: 2014

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References

Jeong, YK, Ha, HK, Yoon, CH, et al. Gastrointestinal involvement in Henoch-Schönlein syndrome: CT findings. AJR Am J Roentgenol 1997;168(4):965–8.CrossRefGoogle ScholarPubMed
Mills, JA, Michel, BA, Bloch, DA, et al. The American College of Rheumatology 1990 criteria for the classification of Henoch-Schönlein purpura. Arthritis Rheum 1990;33(8):1114–21.CrossRefGoogle ScholarPubMed
Shirahama, M, Umeno, Y, Tomimasu, R, et al. The values of colour Doppler ultrasonography for small bowel involvement of adult Henoch-Schönlein purpura. Br J Radiol 1998;71(847):788–91.CrossRefGoogle Scholar

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