Henoch-Schonlein purpura with hemorrhagic bullae in children: report of two cases.
Henoch-Schonlein purpura (HSP) is the most common form of acute vasculitis primarily affecting children. Clinical features include skin rashes, arthritis, abdominal pain and nephritis. Skin biopsy on immunofluorescence often reveals granular depositions of immunoglobulin A (IgA) and C3 within the walls of the dermal vessels as well as in the connective tissue of the upper dermis. The diversity of skin rashes produces confusion in diagnosis of HSP, especially in the presence of bullous lesions. Bullous lesions are very rare in children with HSP, whereas they often appear in adults with HSP. We report 2 cases of HSP in whom hemorrhagic bullae manifested predominantly. In our report, the skin biopsies of both patients revealed typical leukocytoclastic vasculitis without IgA and complement depositions on direct immunofluorescence studies. Dramatic improvement of clinical symptoms and signs was observed within a few days after corticosteroids were administered. There was neither recurrence nor nephritis in these 2 patients.
Liu
Po-Mai
PM
Department of Pediatrics, E-Da Hospital, Kaohsiung, Taiwan, ROC.
Bong
Chin-Nam
CN
Chen
Hsin-Hsu
HH
Huang
Yi-Chuan
YC
Huang
Chao-Cheng
CC
Yang
Kuender D
KD
Wang
Chih-Lu
CL
D001706:Biopsy; D001768:Blister / Q000175:diagnosis / Q000209:etiology*; D002648:Child; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications*; D008297:Male; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000175:diagnosis / Q000209:etiology*