Lumbar Swelling as the Unusual Presentation of Henoch-Schonlein Purpura in a Child.
BACKGROUND
Henoch-Schönlein Purpura (HSP) is a systemic hypersensitivity disease of unknown cause that is characterized by a purpuric rash and systemic manifestations, such as colicky abdominal pain, polyarthralgia, and acute glomerulonephritis. Common complications of HSP that lead to surgical intervention include intussusception, perforation, necrosis, and massive gastrointestinal bleeding. Unusual clinical manifestations of HSP may include edema of the scrotum and eyes. Lumbar swelling is rarely seen as a complication of HSP.


METHODS
A four-year-old boy was admitted to our emergency room with a 7 day history of increasing abdominal pain. Within 48 hours of admission, erythematous macules and palpable purpuric lesions developed on the lower extremities. On the third day of hospitalization, sudden onset of severe back pain, swelling on the lumbar region and refusal to walk were seen. On the fifth day, lumbosacral edema and pain resolved but facial edema developed. He was diagnosed clinically with HSP.


CONCLUSIONS
To the best of our knowledge, only a few cases of HSP with lumbar edema have been reported so far. If the first clinical symptoms of HSP are atypical, clinical progress can be atypical, too.
Department of Pediatrics, Haseki Training and Research Hospital, İstanbul, Turkey.
Mehmet Ali
MA
Duman
Department of Pediatrics, Haseki Training and Research Hospital, İstanbul, Turkey.
Nilgün Selçuk
NS
Duru
Department of Pediatrics, Haseki Training and Research Hospital, İstanbul, Turkey.
Bahar
B
Çalışkan
Department of Pediatrics, Haseki Training and Research Hospital, İstanbul, Turkey.
Hale
H
Sandıkçı
Department of Radiology, Haseki Training and Research Hospital, İstanbul, Turkey.
Ferhat
F
Çengel
Abdominal pain; Henoch Schonlein purpura; facial edema; lumbar swelling; vasculitis