January 16, 2025

16-year-old female presents with hematuria and bloody diarrhea with abdominal colic

By Med-Challenger · 2 minute read

An 16-year-old female presents with hematuria and bloody diarrhea with abdominal colic about 2-3 weeks after an upper respiratory infection. On examination, you note the presence of a palpable, petechial rash and edema of the feet and ankles as pictured (see image).

image (62)

Image.

Which of the following statements is CORRECT about a presumptive diagnosis of Henoch-Schönlein purpura (HSP)?

HSP never spontaneously resolves.
HSP is often complicated by myocarditis and congestive heart failure.
HSP may cause serious GI complications that respond to high-dose steroids.
HSP is unusual in young adults.
The rash of HSP favors the trunk and flexor surfaces of the extremities.

The correct answer is:

HSP may cause serious GI complications that respond to high-dose steroids.

HSP is a vasculitis that is triggered by infections, medications, and other irritant exposures such as chemicals, insect bites, and even vaccinations. In most cases of HSP, resolution occurs spontaneously within 6-8 weeks without treatment and without sequelae, but fluctuations and recurrences over several months can occur. The most serious complication of HSP is persistent nephritis, which can lead to renal failure. Steroids and cytotoxic agents are sometimes used as treatments, but their efficacy is limited. Steroids relieve inflammatory symptoms of arthralgia and may prevent bowel intussusceptions, which occur infrequently, but they have little effect on nephritis or skin manifestations. Their use should be limited to patients presenting with serious gastrointestinal symptoms. HSP may occur at any age, but it is most common in children and young adults.

Migratory arthralgia and arthritis may be present, especially in the lower extremities. Hematuria due to renal vasculitis with glomerular crescents and immunoglobulin A mesangial deposits may occur.

Subsequently, symptoms develop, of which the following are the most common:

Rash (95-100% of cases), especially involving the legs; this is the hallmark of the disease
Abdominal pain and vomiting (35-85%)
Joint pain (60-84%), especially involving the knees and ankles
Subcutaneous edema (20-50%)
Scrotal edema (2-35%)
Bloody stools

References

Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 5th ed. Philadelphia, PA: Mosby Elsevier; 2010.

Scheinfeld NS. Henoch-Schonlein Purpura. http://emedicine.medscape.com/article/984105-overview accessed 08/05/2015

This question appears in Med-Challenger Emergency Medicine Review with CME

Try for free and save. Ace your exams and meet your CME/MOC requirements for just $35 a month!

No matter your program, no matter the size, Med-Challenger for Groups and Institutions can better prepare your program or group, fulfill industry requirements, and increase test scores.