What triad of signs and symptoms is associated with HSP in children?
- • Purpura.
- • Colicky abdominal pain.
- • Arthritis.
HSP (anaphylactoid purpura) is an IgA-mediated small-vessel leukocytoclastic vasculitis. It is the most common vasculitis of childhood and rare in adults. The median age at presentation is 4 to 6 years, and the male to female ratio is about 1.8:1. Approximately 50% of children have a history of preceding upper respiratory tract infection with a variety of organisms. Purpura is usually the initial manifestation but can be preceded by arthritis, edema, testicular swelling , and abdominal pain. Renal disease, typically mild, occurs in 40% to 50% usually within the first 2 months of vasculitis onset. Laboratory abnormalities include an elevated erythrocyte sedimentation rate (ESR; >50%) and elevated serum IgA (37%), and occasionally a positive IgA ANCA. Complement levels are normal, but there is evidence of alternate complement pathway activation. Over 95% of children with HSP have a self-limiting course lasting 2 to 6 weeks. Recurrence is seen overall in 33%, with 20% recurring during the 1st year. Children with renal disease and those aged >8 years are more likely to have recurrences. Up to 5% of children will suffer persistent purpura with or without persistent renal disease. In patients who have renal involvement, 30% develop renal insufficiency and 5% progress to renal failure, especially those who are nephrotic.
