title: Henoch-Schönlein without Purpura: A Case Report and Review Literature.
abstract: Henoch-Schönlein purpura (HSP) is a multi-organ vasculitis involving skin, joints, gastrointestinal tract, and kidneys. The present study reported a 5-year-old boy presenting with intense abdominal pain, bloody diarrhea, and protein-losing enteropathy. Investigations for infectious enteritis were negative. Esophagogastroduodenoscopy showed swelling and erythematous mucosa with hemorrhagic spots at duodenal bulb to the third part of duodenum. Histopathology of endoscopic biopsies revealed non-specific duodenitis. HSP was suspected, based on duodenitis and the presence of inflammatory markers without identifiable causes. Corticosteroid was started resulting in marked improvement of his clinical symptoms. Two weeks later, he developed nephrotic-range proteinuria, thus kidney biopsy was performed. Renal histology was consistent with IgA nephropathy, supporting the diagnosis of HSP This report emphasizes that patients with HSP may not always show visible purpura, and the diagnosis requires a high index of suspicion. GI endoscopy and renal biopsy may be helpful for the diagnosis in selected patients presenting with atypical presentations.
authors.forename: Chaowapong
authors.initials: C
authors.lastname: Jarasvaraparn
authors.forename: Chatmanee
authors.initials: C
authors.lastname: Lertudomphonwanit
authors.forename: Kwanchai
authors.initials: K
authors.lastname: Pirojsakul
authors.forename: Suchin
authors.initials: S
authors.lastname: Worawichawong
authors.forename: Napat
authors.initials: N
authors.lastname: Angkathunyakul
authors.forename: Suporn
authors.initials: S
authors.lastname: Treepongkaruna
mesh_terms: D002675:Child, Preschool; D006801:Humans; D011695:IgA Vasculitis / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology; D008297:Male