title: Henoch-Schönlein purpura from vasculitis to intestinal perforation: A case report and literature review.
abstract: Henoch-Schönlein purpura (HSP) is generally a self-limited vasculitis disease and has a good prognosis. We report a 4-year-old Thai boy who presented with palpable purpura, abdominal colicky pain, seizure, and eventually developed intestinal ischemia and perforation despite adequate treatment, including corticosteroid and intravenous immunoglobulin therapy. Imaging modalities, including ultrasonography and contrast-enhanced computed tomography, could not detect intestinal ischemia prior to perforation. In this patient, we also postulated that vasculitis-induced mucosal ischemia was a cause of the ulcer, leading to intestinal perforation, and high-dose corticosteroid could have been a contributing factor since the histopathology revealed depletion of lymphoid follicles. Intestinal perforation in HSP is rare, but life-threatening. Close monitoring and thorough clinical evaluation are essential to detect bowel ischemia before perforation, particularly in HSP patients who have hematochezia, persistent localized abdominal tenderness and guarding. In highly suspicious cases, exploratory laparotomy may be needed for the definite diagnosis and prevention of further complications.
authors.affiliation: Butsabong Lerkvaleekul, Soamarat Vilaiyuk, Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Butsabong
authors.initials: B
authors.lastname: Lerkvaleekul
authors.affiliation: Butsabong Lerkvaleekul, Soamarat Vilaiyuk, Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Suporn
authors.initials: S
authors.lastname: Treepongkaruna
authors.affiliation: Butsabong Lerkvaleekul, Soamarat Vilaiyuk, Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Pawaree
authors.initials: P
authors.lastname: Saisawat
authors.affiliation: Butsabong Lerkvaleekul, Soamarat Vilaiyuk, Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Pornsri
authors.initials: P
authors.lastname: Thanachatchairattana
authors.affiliation: Butsabong Lerkvaleekul, Soamarat Vilaiyuk, Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Napat
authors.initials: N
authors.lastname: Angkathunyakul
authors.affiliation: Butsabong Lerkvaleekul, Soamarat Vilaiyuk, Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Nichanan
authors.initials: N
authors.lastname: Ruangwattanapaisarn
authors.affiliation: Butsabong Lerkvaleekul, Soamarat Vilaiyuk, Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
authors.forename: Soamarat
authors.initials: S
authors.lastname: Vilaiyuk
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging; D002675:Child, Preschool; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D011695:IgA Vasculitis / Q000150:complications*; D007077:Ileal Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D007416:Intestinal Perforation / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D065666:Mesenteric Ischemia / Q000000981:diagnostic imaging / Q000209:etiology*; D008775:Methylprednisolone / Q000627:therapeutic use; D012640:Seizures / Q000209:etiology; D014057:Tomography, X-Ray Computed; D020293:Vasculitis, Central Nervous System / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology
chemical_list: D005938:Glucocorticoids; D008775:Methylprednisolone
keywords: Bowel ischemia; Corticosteroids; Henoch-Schönlein purpura; Intestinal perforation; Peritonitis; Vasculitis