Henoch-Schönlein Purpura

• starting as pink macules or wheals and developing into petechiae, raised purpura, or larger ecchymoses
• occur in lower extremities, buttocks
• typically lasting 3-10 days, and may recur up to 4 mo after initial presentation
• subcutaneous edema localized to the dorsa of hands and feet, periorbital area, lips, scrotum, or scalp is also common

• knees, ankles, elbows, and wrists are commonly affected

• usually related to mesenteric vasculitis

• characterized by proteinuria, hematuria, and hypertension, frank nephritis, nephrotic syndrome, and acute or chronic renal failure

• caused by hypertension or central nervous system (CNS) vasculitis,
• e.g. intracerebral hemorrhage, seizures, headaches, depressed level of consciousness, cranial or peripheral neuropathies, and behavior changes

other small vessel vasculitides

infections

acute poststreptococcal glomerulonephritis

hemolytic-uremic syndrome

coagulopathies

papular-purpuric glove and sock syndrome

SLE

other vasculitides (urticarial, hypersensitivity)

thrombocytopenia

infantile acute hemorrhagic edema (AHE)

• isolated cutaneous leukocytoclastic vasculitis that affects infants <2 yr of age
• resembles HSP clinically
• manifests as fever; tender edema of the face, scrotum, hands, and feet; and ecchymosis (usually larger than the purpura of HSP) on the face and extremities, trunk is spared

Reference

• Nelson page 2131/6873