henach schonlein purpura in hepatitis a dr (major) d ravi shankar md consultant physician manipal...
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HENACH SCHONLEIN PURPURAINHEPATITIS A
Dr (MAJOR) D RAVI SHANKAR MD
CONSULTANT PHYSICIANMANIPAL HOSP. SALEM
Mr Kiran 17 yrs C/o
Fever - 1 wk Nausea/vomiting Jaundice Red patches both dorsum of foot Burning both foot
O/E Conscious, oriented, febrile Icteric Palpable purpuric patches over both dorsum of foot. Vitals
PR – 120 BP - 90/60 SPo2 – 97%
CVS - NAD RS - NAD CNS - NAD ABD - Mild tender hepatomegaly
LAB
Hemogram - N USG ABD – mild HS megaly LFT
TB - 3.2 DB - 2.1 IDB - 1.1 SGOT - 1500 SGPT - 1900 ALP - 324 PROTEINS - N
LAB
INR - 1.6 SEROLOGY
HIV - -ve HBsAG - -ve Anti HCV - -ve Hep E - -ve Anti HAV - positive
Serum ANA – neg CRP - +ve
LAB
PS study – N 24 hrs urinary protein – 534 Mg RA factor - +ve Lepto – Ig M –ve Malarial Ag –ve Renal – N Sugars - N
Skin biopsy
Neutrophilic infiltration in dermis and perivascular region
DIAGNOSIS
HENOCH SHONLEIN PURPURA
TREATMENT GIVEN
INJ SOLUMEDRAL 125mg IV BD 3DAYS
SUPPORTIVE MEASURES FOR HEPATITIS
PT RECOVERED
STEROIDS CONTINUED FOR 3 WKS
NAME Begam Palaniappan Suman
AGE 45 54 30
PRE-disposing Fever,diarrhea Fever URI wk before
Purpura legs legs legs
Symp Abd pain/ diarrhea Abd pain/ diarrhea -
Burning feet + + +
Co morbid DM DM/SHT -
24 hr pr 942 117 550
CRP +VE(96) +ve(140) -VE
ANA +VE(dsDNA –ve) -ve +VE (dsDNA -ve)
RA -ve -ve -VE
Serology -ve HBsAg +ve -ve
TC 10.9 9.0 9,7
Biopsy Perivascular inflammation with hemorrhage
Leucocytoclastic
vasculitis
Leucocytoclastic
Vas culitis (IgA IF sent)
OTHER THREE PATIENTS
CAUSES
Viral and bacterial infections, such as strep throat and parvovirus infection — nearly half the children with Henoch-Schonlein purpura develop the disease after an upper respiratory infection
Certain medicines - antibiotics and antihistamines
Insect bites HEPATITIS B & C
Some vaccinations - measles, typhoid, yellow fever and cholera , varicella, Hep B
Cold weather Certain chemicals
SYMPTOMS Rashes and bruising. 100%
Legs, buttocks, Rarely, the rash may spread to the upper part of the body, but it is usually on
the parts of the body that “hang down,” like the legs, buttocks, elbows, and even earlobes.
Abdominal pain. 80% two-thirds of people with HSP experience pain in the stomach that may cause
vomiting or blood in the stool. Intussuseption in children
Arthritis. 80 percent have pain and swelling in the knees and ankles, less frequently in the
elbows and wrists. NO residual effects
Kidney involvement. Hematuria & PROTEINURIA - 40 % Mostly no residual damage May progress to Ig A Nephropathy
Classical Purpura
Rare presentation
[Hepatitis A infection and Henoch-Schonlein purpura: a rare association].
[Article in French] Chemli J, Zouari N, Belkadhi A, Abroug S, Harbi A. Source Service de pédiatrie, CHU Sahloul, Sousse 4054, Tunisie.
[email protected] <[email protected]> Abstract OBSERVATION: A 10-year-old boy presented cholestatic hepatitis
A virus infection confirmed by IGM anti-HAV antibody. Three days after admission, he presented a palpable purpuric rash on the declivous regions, arthralgia and abdominal pain. He met all criteria set by the American College of Rheumatology (ACR) for Henoch Schonlein purpura. The evolution was gradually favorable with no renal involvement (recoil of 3 years and half). CONCLUSION: Henoch Schonlein purpura is an exceptional extra-hepatic manifestation of hepatitis A infection.
PMID: 15475276 [PubMed - indexed for MEDLINE]
CONCLUSION
•MOSTLY FOLLOWS URI/LRI
•OUR CASE FOLLOWED HEPATITIS A
•MOSTLY SELF LIMITING
•MAY HAVE LONG TERM EFFECTS ON KIDNEYS
•TREATMENT WITH STEROIDS WILL PREVENT THIS
•FOLLOW UP WITH URINE ANALYSIS UP TO 6 MONTHS
