Henoch-Schönlein Purpura with Gastrointestinal Tract Involvement and Nephritis in Children in Limited Healthcare Settings
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Dewi Wulan Sari*
Ike Dwi Wahyuni
Henoch-Schönlein Purpura (HSP), or IgA vasculitis, is the most common systemic vasculitis in children, characterized by a clinical tetrad of palpable purpura, arthritis/arthralgia, abdominal pain, and renal involvement. Gastrointestinal manifestations may mimic surgical acute abdomen, while nephritis determines the long-term prognosis. This case report aims to present the management of HSP with multi-organ involvement in a limited-resource setting. An 8-year-old girl presented with nausea, vomiting, and severe abdominal pain, preceded by the appearance of a reddish rash on the extremities and buttocks one week prior. Physical examination revealed diffuse palpable purpura and epigastric tenderness. Investigations showed leukocytosis, microscopic hematuria, and mild proteinuria. Abdominal ultrasound revealed positive sonographic tenderness at McBurney’s point without signs of acute appendicitis or intussusception. The patient was diagnosed with HSP with gastrointestinal involvement and nephritis. The patient was treated conservatively with intravenous hydration, antibiotics, gastric mucosa protectors, and systemic corticosteroids. Significant clinical improvement in abdominal pain and skin rash was achieved following corticosteroid administration, and the patient was discharged with a prednisone tapering regimen. Early diagnosis of HSP is crucial to avoid unnecessary surgical intervention in patients with severe abdominal pain. Corticosteroids are effective in relieving acute gastrointestinal symptoms. Long-term monitoring of renal function is mandatory given the risk of chronic kidney disease progression, even in cases with mild initial symptoms.
Amelia, H., Karera, A. D., & Tarannita, C. (2025). Gastrointestinal Dominant Henoch Schönlein Purpura in Children: A Report of Two Cases. International Journal of Health Engineering and Technology, 4(4), 1119–1124. https://doi.org/10.55227/ijhet.v4i4.461
Çağlayan, Ş. (2025). Gastrointestinal Involvement in Pediatric IgA Vasculitis: Clinical Features, Risk Factors, and Treatment Approach. Comprehensive Medicine, 17(1), 22–28. https://doi.org/10.14744/cm.2024.09609
Chen, J. Y., & Mao, J. H. (2015). Henoch-Schönlein purpura nephritis in children: incidence, pathogenesis and management. World Journal of Pediatrics, 11(1), 29–34. https://doi.org/10.1007/s12519-014-0534-5
Davin, J. C., & Coppo, R. (2014). Henoch-Schönlein purpura nephritis in children. Nature Reviews Nephrology, 10(10), 563–573. https://doi.org/10.1038/nrneph.2014.126
Ekinci, R. M. K., Balci, S., Melek, E., Karabay Bayazit, A., Dogruel, D., Altintas, D. U., & Yilmaz, M. (2020). Clinical manifestations and outcomes of 420 children with Henoch Schönlein Purpura from a single referral center from Turkey: A three-year experience. Modern Rheumatology, 30(6), 1039–1046. https://doi.org/10.1080/14397595.2019.1687074
Ghazanfar, M., Sarwar, H., Cheema, M. H., Cheema, M. H., Fatima, N., & Sheikh, A. H. (2024). Spectrum of Clinical Manifestations among Paediatrics and Adult Patients of Idiopathic Thrombocytopenic Purpura Presenting to Tertiary Care Hospital. Pakistan Journal of Health Sciences, 138–141. https://doi.org/10.54393/pjhs.v5i05.1574
Hamdan, J. M., & Barqawi, M. A. (2008). Henoch-Schonlein purpura in children. Influence of age on the incidence of nephritis and arthritis. Saudi Medical Journal, 29(4), 549–552. https://doi.org/10.15537/1658-3175.4294
Jarasvaraparn, C., Lertudomphonwanit, C., Pirojsakul, K., Worawichawong, S., Angkathunyakul, N., & Treepongkaruna, S. (2016). Henoch-schönlein without purpura: A case report and review literature. Journal of the Medical Association of Thailand, 99(4), 441–445. https://pubmed.ncbi.nlm.nih.gov/27396230/
Jaszczura, M., Dyga, K., Bryłka, A., Góra, A., & Machura, E. (2018). IgA vasculitis, formerly known as Henoch-Schönlein purpura – the most common vasculitis in children. Pediatria Polska, 93(4), 336–342. https://doi.org/10.5114/polp.2018.78000
Kurnia, B. (2019). Henoch-schonlein purpura in children: The role of corticosteroids. Open Access Macedonian Journal of Medical Sciences, 7(11), 1812–1814. https://doi.org/10.3889/oamjms.2019.538
Oni, L., & Sampath, S. (2019). Childhood IgA vasculitis (Henoch Schonlein Purpura)-advances and knowledge gaps. Frontiers in Pediatrics, 7(JUN), 1–10. https://doi.org/10.3389/fped.2019.00257
Patel, T. (2023). A Rare Case of Idiopathic Thrombocytopenic Purpura with Unusual Clinical Manifestations . Wiley. https://doi.org/10.22541/au.168553903.36073314/v1
Putri, A. T., & Awalia. (2022). Diagnosis and management of Henoch-Schonlein purpura in Indonesian elderly with severe complication: A rare case. Annals of Medicine & Surgery, 77. https://doi.org/10.1016/j.amsu.2022.103650
Rajalakshmi, P. P., & Srinivasan, K. (2015). Gastrointestinal manifestations of Henoch-Schonlein purpura: A report of two cases. World Journal of Radiology, 7(3), 66. https://doi.org/10.4329/wjr.v7.i3.66
Reid-Adam, J. (2014). Henoch-schönlein purpura. Pediatrics in Review, 35(10), 447–449. https://doi.org/10.1542/pir.35-10-447
Saulsbury, F. T. (1987). The Role of IgA1 Rheumatoid Factor (RF) in the Formation of IgA-Containing Circulating Immune Complexes (CIC) in Henoch-Schönlein Purpura (HSP). Pediatric Research, 21(4), 317A-317A. https://doi.org/10.1203/00006450-198704010-00898
Shin, J. Il. (2023). IgA Vasculitis Nephritis (Henoch-Schönlein Purpura Nephritis). In Pediatric Kidney Disease (pp. 765–782). Springer International Publishing. https://doi.org/10.1007/978-3-031-11665-0_27
Sugianti, I., Akib, A. A., & Soedjatmiko, S. (2016). Karakteristik Purpura Henoch-Schönlein pada Anak di Rumah Sakit Cipto Mangunkusumo. Sari Pediatri, 16(2), 128. https://doi.org/10.14238/sp16.2.2014.128-35
Wardhani, R. L., & Saroh, S. A. (2023). Management of Henoch-Schonlein Purpura with Gastrointestinal Manifestations in Children. Muhammadiyah Medical Journal, 4(1), 15. https://doi.org/10.24853/mmj.4.1.15-24
Yahyaoui, S., Mohamed, L., Rania, B. R., Sonia, M., Samir, B., & Sammoud, A. (2018). Risk Factors for Severe Gastrointestinal Involvement in Childhood HenochSchoenlein Purpura. Journal of Clinical Gastroenterology and Hepatology, 02(02), 10–13. https://doi.org/10.21767/2575-7733.1000041
