Henoch-Schönlein Purpura in Children: a 17-year Experience

A descriptive study of one hundred and five Henoch-Schonlein purpura (HSP) patients (57 males, 48 females) treated during 1987-2003 in Department of Pediatrics, Faculty of Medicine Siriraj Hospital, was conducted. The male to female ratio was 1.2: 1. The mean age of the patients was 7.1 years (range 2-15). Most patients lived in Bangkok and the central region of Thailand. HSP most commonly occurs in the rainy season. Clinical manifestations were rash (100%), arthralgia (61.9%), arthritis (25.7%), abdominal pain (66.7%), gastrointestinal bleeding (14.3%: stool occult blood 11.4% and hematemesis or melena 2.9%), nephritis (37.1%: microscopic hematuria 29.5%, gross hematuria 7.6%), proteinuria (23.8%), nephrotic syndrome (1%), and hypertension (1%). The most characteristic rash was purpura, mainly on the lower extremities. Arthritis and/or arthralgia commonly affected feet and ankles. The abdominal pain was commonly localized at epigastrium and umbilical area. Gastrointestinal complications included upper gastrointestinal bleeding, appendicitis, duodenal ulcer, gangrenous intussusception, and gastritis. The most common presenting signs and symptoms were rash. Of all patients, 34.3% developed recurrent symptoms including abdominal pain, nephritis, and rash mostly occurring within the first 3 months after the initial resolution (range 2 days-9.6 years).  The mainstay of management was supportive care. The patients with severe abdominal pain received prednisolone. Prednisolone and cyclophosphamide were only given to severe nephritis patient with a good outcome.