Clinical Presentation and Outcome of Children with Henoch-Schönlein Purpura in a Tertiary Care Hospital
Mamun Miah1, Kazi Zahidul Hoque2, Shubhra Prakash Paul3, Akhand Tanzih Sultana4, Md.Jahangir Alam5
Background: Henoch-Schönlein purpura (HSP) is an inflammatory disorder
characterized by a generalized vasculitis involving the small vessels of the skin, GI tract,
kidneys, joints, and, rarely, the lungs and CNS. It is the most common vasculitis in
children, twice as common in boys, peaks during the winter months and is often preceded
by an upper respiratory tract infection. Despite much research, the cause is unknown.
Objective: The aim of this research is to study the clinical characteristics, diagnosis,
prognosis and joint and kidney involvement in children with Henoch Schonlein
Purpura in order to expand our knowledge about the disease.
Methods: This retrospective study was conducted in Dhaka Shishu Hospital &
Bangladesh Institute of Child Health, Dhaka between July 2012 to June 2014 on 54
children admitted with HSP. The diagnosis of HSP was based on purpura, acute
arthritis or acute arthralgia, accompanied by abdominal pain, histopathologically
confirmed proliferative glomerulonephritis and renal involvement. Children with HSP
less than 14 years of age, without any history/evidence of allergic or hematological
disorders, systemic lupus erythematosus, renal or any other immunological disorders,
and active infections (such as, tuberculosis, hepatitis B and other contagious diseases)
were included in the study.
Results: Majority (63%) of the children was above 5 years old with mean age being 6
years (range: 1-10 years). Males outnumbered females by 3:2. The children with HSP
invariably presented with skin rash (100%) followed by joint swelling (48.1%), arthralgia
(44.4%), abdominal pain (44.4%), nausea/vomiting (40.7%), arthritis (37%) and GI
bleeding (37%). The next common manifestations were acute nephritis (22.2%),
proteinuria (14.8%), hematuria (11.1%), nephrotic syndrome (22.2%) and fever (22.2%).
Thigh was the predominant site of rash (92.6%) followed by waist & hip (63%), foot &
calf (59.3%), upper limb (29.6%) and abdomen (22.2%). Knee and ankle were frequently
the affected joints. Elbow was less commonly affected. The mean ALT and AST were
within normal range. The kidney function was also normal. Following interventions
none of the patients had skin rash, arthralgia, joint swelling, nausea/vomiting,
abdominal pain. Occult blood test was negative in all cases.