PE21.2 | Henoch Schonlein Purpura — Summary & Reflection

KEY TAKEAWAYS

Henoch Schönlein Purpura (IgA vasculitis) is the most common childhood systemic vasculitis, driven by aberrant IgA1 glycosylation and immune complex deposition in small vessels. Diagnosis requires the mandatory criterion of palpable purpura (non-thrombocytopenic, normal platelet count) plus at least one of: abdominal pain, arthritis, renal involvement, or IgA on biopsy (EULAR/PRINTO/PRES 2010). The clinical tetrad is purpura + arthritis + abdominal pain + nephritis — appearing sequentially over days to weeks. Most cases resolve within 4–6 weeks; the key monitoring target is the kidney (urine dipstick weekly × 4–6 weeks, then monthly × 6 months). Corticosteroids shorten abdominal pain and arthritis but do not prevent renal disease. Severe nephritis (nephrotic proteinuria, hypertension, crescentic glomerulonephritis) requires prednisolone + azathioprine under nephrology supervision. Recurrence occurs in ~30% within 4–6 months.

REFLECT

Consider the family of a child discharged from your ward after HSP. The parents saw the rash clear, the pain go away, and the child resume playing football — they are relieved and feel the illness is 'cured.' How would you communicate the concept of ongoing renal monitoring to a family who understandably wants closure? How would you balance the reassurance that most children do well with the vigilance required to detect the minority who develop nephritis? What does this teach you about the relationship between visible symptoms and invisible organ damage in paediatric disease?