Henoch-Schönlein without Purpura: A Case Report
and Review Literature
Chaowapong Jarasvaraparn MD*, Chatmanee Lertudomphonwanit MD*, Kwanchai Pirojsakul MD*,
Suchin Worawichawong MD**, Napat Angkathunyakul MD**, Suporn Treepongkaruna MD*
Affiliation :
* Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
** Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Henoch-Schönlein purpura (HSP) is a multi-organ vasculitis involving skin, joints, gastrointestinal tract, and
kidneys. The present study reported a 5-year-old boy presenting with intense abdominal pain, bloody diarrhea, and
protein-losing enteropathy. Investigations for infectious enteritis were negative. Esophagogastroduodenoscopy showed
swelling and erythematous mucosa with hemorrhagic spots at duodenal bulb to the third part of duodenum. Histopathology
of endoscopic biopsies revealed non-specific duodenitis. HSP was suspected, based on duodenitis and the presence of
inflammatory markers without identifiable causes. Corticosteroid was started resulting in marked improvement of his clinical
symptoms. Two weeks later, he developed nephrotic-range proteinuria, thus kidney biopsy was performed. Renal histology
was consistent with IgA nephropathy, supporting the diagnosis of HSP. This report emphasizes that patients with HSP may
not always show visible purpura, and the diagnosis requires a high index of suspicion. GI endoscopy and renal biopsy may
be helpful for the diagnosis in selected patients presenting with atypical presentations.
Keywords : Abdominal pain, Gastrointestinal hemorrhage, Henoch-Schönlein purpura, IgA nephropathy, Vasculitis
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