Gastrointestinal involvement as the initial manifestation in children with Henoch-Schönlein Purpura - Clinical analysis of 27 cases

A retrospective study was conducted to analyze the clinical and laboratory features, results of imaging studies, and course and treatment in 27 children with Henoch-Schönlein purpura (HSP) who initially presented with only abdominal symptoms. There were 17 boys and 10 girls, aged 6.7±0.5 years. The abdominal symptoms preceded the purpura for 10.2±1.9 days, ranging from 3 to 48 days. The main abdominal symptoms were periumbilical pain (77.8%); vomiting (51.9%); diarrhea (29. 6%); pain mimicking appendicitis (22.2%) and bloody stool (14.8%). Laboratory findings revealed leukocytosis (88.9%), thrombocytosis (77.8%), positive stool guaiac tests (77.8%), and elevation of serum C-reactive protein (71.4%). Plain film is of limited use, but emergent abdominal sonography can be helpful in patients suspected of appendicitis. Unnecessary laparotomy was performed in three patients, whose pain persisted after the operation. Corticosteroid, given upon the appearance of rash, alleviated the abdominal pain in 2.4±0.2 days. All patients had recovered completely at sixmonth follow-up, except that three had persistent microscopic hetnaturia. A high index of suspicion and early diagnosis of HSP based on clinical features, laboratory data and the findings from diagnostic imaging may avoid unnecessary surgery. Early use of corticosteroid may reduce the suffering in these children.