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A form of anaphylactoid or nonthrombopenic purpura that is the most common connective tissue disorder in children. This syndrome is an allergic reaction to a β-hemolytic streptococci. It usually presents 1 to 3 weeks after an upper respiratory tract infection. Characterized by a purpuric rash, painful swollen joints, abdominal pain with vomiting. Onset in preschool age with peak in spring and fall, occurring more often in males than females.

Schönlein-Henoch purpura

Purpuric rash in an adult patient with Schönlein-Henoch purpura.

Anaphylactoid Purpura; Allergic Nonthrombocytopenic Purpura; Allergic Purpura-Arthralgia-Gastrointestinal Symptoms; Peliosis Rheumatica; Purpura Abdominalis; Purpura Infectiosa Acuta.

The most common vasculitis in children, usually occurring beyond age 2 years until adolescence. Idiopathic; male:female ratio = 3:2.

Leukoclastic vasculitis of small vessels, with the potential for necrotizing vasculitis of the kidney and gastrointestinal tract. IgA and C3 deposition is found in the small vessels of the skin and the glomeruli. Etiology is unknown, although it occurs following exposure to infection and drugs.

Based on clinical findings of rash over the lower extremities and buttocks, arthritis, and colicky abdominal pain. Fifty percent of patients have fever and palpable purpura. IgA deposition may also be found in the skin, and serum titers may also be elevated.

Rash over lower extremities and buttocks, arthritis, abdominal pain that may mimic an acute abdomen, intussusception, renal disease (10 to 40%), although usually resolves over the long term. Less frequent clinical features include: pulmonary hemorrhage, convulsions, hemiparesis, mononeuropathies, scrotal vasculitis, and pancreatitis. No specific treatment, although acute attacks may be treated with hydration, non-steroidal antiinflammatory drugs (NSAIDs), and steroids. Prognosis favors recovery in weeks to months.

Check a complete cell blood count (CBC) and electrolytes. Query for pulmonary involvement.

Consider renal dysfunction when choosing drugs. Regional anesthesia is not contraindicated with normal platelet counts or lack of bleeding diathesis.

The administration of anesthetic agents or other medications dependent on renal elimination must be avoided. Any medication with potential renal toxic by-products must be avoided in the presence of renal dysfunction.

Athreya BH: Vasculitis in children. Pediatr Clin North Am 42:1239, 1995.  [PubMed: 7567194]

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