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Montorfani-Janett VML, Montorfani GE, Lavagno C, Gualco G, Bianchetti MG, Milani GP, Lava SAG, Cristallo Lacalamita M. External Male Genitalia in Henoch-Schönlein Syndrome: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9081154. [PMID: 36010045 PMCID: PMC9406875 DOI: 10.3390/children9081154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/16/2022] [Accepted: 07/26/2022] [Indexed: 11/23/2022]
Abstract
The external genitalia are notoriously implicated in every fifth male with Henoch−Schönlein syndrome. Nonetheless, the underlying conditions are poorly categorized. To characterize the involvement of the external male genitalia in this vasculitis, we performed a systematic review of the literature. For the final analysis, we selected 85 reports published between 1972 and 2022, which reported on 114 Henoch−Schönlein cases (≤ 18 years, N = 104) with a penile (N = 18), a scrotal (N = 77), or both a penile and a scrotal (N = 19) involvement. The genital involvement mostly appeared concurrently with or after the cutaneous features of Henoch−Schönlein syndrome, while it preceded the presentation of Henoch−Schönlein syndrome in 10 cases. Patients with penile involvement (N = 37) presented with swelling (N = 26), erythema (N = 23), and purpuric rash (N = 15). Most patients were otherwise asymptomatic except for transient micturition disorders (N = 2) or priapism (N = 2). Patients with scrotal involvement (N = 96) presented with pain (N = 85), swelling (N = 79), erythema (N = 42), or scrotal purpura (N = 22). The following scrotal structures were often involved: scrotal skin (N = 83), epididymis (N = 49), and testes (N = 39). An ischemic testicular damage was noted in nine patients (four with torsion and five without). The scrotal skin involvement was mostly bilateral, while that of the epididymis and testis were mostly (p < 0.0001) unilateral (with a significant predilection for the left side). In conclusion, this analysis allows for better categorization of the involvement of external male genitalia in Henoch−Schönlein vasculitis. Scrotal involvement can result from skin inflammation, epididymitis, orchitis, or testicular ischemia.
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Affiliation(s)
- Valentina M. L. Montorfani-Janett
- Family Medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland; (V.M.L.M.-J.); (G.E.M.); (M.G.B.)
| | - Gabriele E. Montorfani
- Family Medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland; (V.M.L.M.-J.); (G.E.M.); (M.G.B.)
| | - Camilla Lavagno
- Pediatric Emergency Department, University Children’s Hospital Zurich, 8032 Zurich, Switzerland;
| | - Gianluca Gualco
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland;
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Mario G. Bianchetti
- Family Medicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland; (V.M.L.M.-J.); (G.E.M.); (M.G.B.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Gregorio P. Milani
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Sebastiano A. G. Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois and University of Lausanne, 1011 Lausanne, Switzerland
- Heart Failure and Transplantation, Department of Paediatric Cardiology, Great Ormond Street Hospital, London WC1N 3JH, UK
- Correspondence:
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Penile involvement of immunoglobulin a vasculitis/Henoch-Schönlein purpura. J Pediatr Urol 2021; 17:409.e1-409.e8. [PMID: 33558175 DOI: 10.1016/j.jpurol.2021.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/05/2021] [Accepted: 01/14/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Immunoglobulin A vasculitis/Henoch-Schönlein purpura (IgAV/HSP) is a leukocytoclasia vasculitis of childhood, predominantly affecting the skin, joints, gastrointestinal tract, and kidneys. The involvement of the penis is rare. OBJECTIVE We aimed to describe this rare manifestation of IgAV/HSP and to review the previous studies, including similar cases. METHODS Clinical data were reviewed for two children of penile involvement of IgAV/HSP in our hospital. More clinical cases were retrieved from the databases of PubMed/MEDLINE and Scopus from database inception to February 1, 2020. RESULTS We presented two boys aged three and five years both of whom had penile lesions after presenting with the typical rash of IgAV/HSP on lower extremities. The penile lesions improved entirely in a few days without treatment in one and with corticosteroid treatment in the other. The literature review revealed 12 articles describing 20 patients with penile involvement of IgAV/HSP. The penile findings were edema, erythema, ecchymosis, purpuric rash, edema, color change, stiffness of the shaft or prepuce, and tenderness. Penile lesions appeared before the purpuric rash of IgAV/HSP in three of 22 patients. The penile involvement could make the diagnosis challenging especially if the penile lesions appear before the typical rash of the disease. The lesions improved entirely in the short term in all patients; in five without treatment in fifteen after corticosteroid or immunosuppressive drug treatment. CONCLUSIONS It is important to raise awareness about this rare manifestation among health care providers. It is not clear whether corticosteroid treatment should be initiated for treatment since it seems as a self-limited feature. Treatment with corticosteroids could be considered in the treatment of selected cases especially with systemic involvement.
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Al E'ed A. Henoch-Schönlein purpura in Saudi Arabia: characteristics and rare vital organ involvement. Minerva Pediatr (Torino) 2020; 73:363-370. [PMID: 32960004 DOI: 10.23736/s2724-5276.20.05962-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Henoch-Schönlein purpura (HSP) is the most common small vessel vasculitis in children with an annual incidence of between 10 and 30 per 100,000. It is an inflammation that affects many organs primarily in the skin, gastrointestinal (GI) tract, musculoskeletal, also vital organs like kidneys and lungs which may lead to chronic kidney disease and pulmonary hemorrhage. In this review, we are showing the characteristics of Saudi patients with HSP and the relation with preceding infections, gender, and seasonal variations in addition to the common and most severe systemic involvements. We found cases that were challenging to diagnose and others with unfortunate fetal complications.
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Affiliation(s)
- Ashwaq Al E'ed
- Department of Pediatrics, College of Medicine, Qassim University, Qassim, Saudi Arabia -
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Hewett KM, Titus MO. Acute Genitourinary Swelling and Erythema as Presenting Symptoms of Henoch-Schonlein Purpura. Pediatr Emerg Care 2016; 32:384-5. [PMID: 27253355 DOI: 10.1097/pec.0000000000000822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Henoch-Schonlein purpura (HSP) may present in a variety of ways, most commonly with joint pain or the distinctive palpable purpura. Genitourinary manifestations of HSP are less common and may precede the classic signs and symptoms of HSP, making the diagnosis difficult. We report a case of a 19-month-old boy with penile and scrotal erythema and swelling at presentation who was later diagnosed with HSP.
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Affiliation(s)
- Kathryn M Hewett
- From the *Summerville Pediatric Emergency Department, Summerville and †Division of Pediatric Emergency Medicine,Medical University of South Carolina, Charleston, SC
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Paydary K, Emamzadeh Fard S, Mahboubi AH, Ziaee V, Moradinejad MH, Kajbafzadeh AM. Penile Skin Involvement as the First Presentation of Henoch-Schonlein Purpura Report of Nine Cases and Review of Literature. IRANIAN JOURNAL OF PEDIATRICS 2015; 25:e2177. [PMID: 26396696 PMCID: PMC4575794 DOI: 10.5812/ijp.2177] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 06/13/2015] [Accepted: 07/10/2015] [Indexed: 01/12/2023]
Abstract
Introduction: Involvement of penis is a rare presentation in henoch-schonlein purpura (HSP). The presentations are mainly due to the deposition of immunoglobulin A (IgA) into the vessel walls. In this report, we present the clinical history of nine HSP cases that presented with penile skin involvement. Case Presentation: All patients were referred in the acute phase of HSP. Penile skin involvement was evident as erythema, edema, ecchymosis, or induration of prepuce and/or penile shaft, that appeared simultaneously with skin rash in seven patients. Gastrointestinal involvement was positive in six patients. Patients were treated with steroids and follow up visits were normal except for one patient that developed crescentic glomerulonephritis. Conclusions: We present nine cases of HSP with penile involvement in order to indicate another rare aspect of HSP and its possible complications as well as its appropriate treatment.
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Affiliation(s)
- Koosha Paydary
- Pediatric Urology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, IR Iran
| | - Sahra Emamzadeh Fard
- Pediatric Urology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, IR Iran
| | - Amir Hassan Mahboubi
- Pediatric Urology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Vahid Ziaee
- Pediatric Rheumatology Research Group, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Children’s Medical Center, Pediatrics Center of Excellence, Tehran, IR Iran
| | - Mohammad Hassan Moradinejad
- Children’s Medical Center, Pediatrics Center of Excellence, Tehran, IR Iran
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Abdol Mohammad Kajbafzadeh, Pediatric Urology Research Center, Tehran, IR Iran. Tel/Fax: +98-2122069451, E-mail:
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Tewary KK, Khodaghalian B, Narchi H. Acute penile pain and swelling in a 4-year-old child with Henoch-Schönlein purpura. BMJ Case Rep 2015; 2015:bcr-2013-202341. [PMID: 25858918 DOI: 10.1136/bcr-2013-202341] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Henoch-Schönlein purpura (HSP) is the most common vasculitis found in children. It usually affects the small vessels of the skin, joints, gastrointestinal tract and, more rarely, kidneys, brain, lungs and genitalia. Apart from classical presentation with purpuric rashes around buttocks and lower extremities, features such as arthralgia, abdominal pain, haematuria and proteinuria as well as scrotal swelling have been described in the literature. Penile involvement is rare and is not commonly described. We describe a child with HSP who developed penile involvement. We review the literature of all the cases reported in detail, in order to highlight useful clinical presentation, management and prognosis of this rare manifestation.
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Affiliation(s)
- Kishor Kumar Tewary
- Department of Paediatrics, University Hospitals of North Midlands, Stoke On Trent, UK
| | | | - Hassib Narchi
- Faculty of Medicine, United Arab Emirates University, Al-Ain, UAE
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Peracha J, Morgan MD. Urological manifestations and treatment of the primary systemic vasculitides. World J Clin Urol 2015; 4:5-20. [DOI: 10.5410/wjcu.v4.i1.5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 11/17/2014] [Accepted: 12/31/2014] [Indexed: 02/06/2023] Open
Abstract
The primary systemic vasculitides (PSV) are a group of rare inflammatory disorders affecting blood vessels of varying size and multiple organs. Urological manifestations of PSV are uncommon. Testicular vasculitis is the most commonly reported finding and is associated with Polyarteritis Nodosa (PAN), Henoch-Schönlein Purpura (HSP), anti-neutrophil cytoplasm antibody associated Vasculitides (AAV), Giant Cell Arteritis (GCA) and Kawasaki disease. Prostatic vasculitis has been reported in association with GCA and AAV. Ureteric involvement has been noted in PAN, HSP and AAV. Other urogenital manifestations of PSV include genital ulceration and bladder dysfunction in Behçets Disease and haematuria which is commonly seen in many of the PSV. Finally, therapies used to treat the PSV, especially cyclophosphamide, are associated with urological side-effects including haemorrhagic cystitis and urothelial malignancy. The aim of this review is to examine how the urological system is involved in the PSV. Each PSV is examined in turn, with a brief clinical description of the disease followed by a description of the urological manifestations and management. Identification of urological manifestations of PSV is important as in many cases symptoms may improve with immunosuppressive therapy, avoiding the need for invasive surgery. Additionally, patients who present with isolated urogenital PSV are at higher risk of developing subsequent systemic vasculitis and will need to be followed up closely.
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Hiram-Karasmanis R, Smith RG, Radina M, Soboleski DA. Abdominal wall and labial edema presenting in a girl with Henoch-Schönlein purpura: a case report. J Med Case Rep 2010; 4:98. [PMID: 20350324 PMCID: PMC2857854 DOI: 10.1186/1752-1947-4-98] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Accepted: 03/29/2010] [Indexed: 11/29/2022] Open
Abstract
Introduction Henoch-Schönlein purpura is a common immunoglobulin A-mediated vasculitic syndrome in children, characterized by purpuric rash, arthritis and abdominal pain. Renal involvement, manifested by the presence of hematuria and/or proteinuria, is also frequently seen. In most cases, patients with this disease achieve complete recovery, but some progress to renal impairment. Gastro-intestinal manifestations are present in two-thirds of affected patients and range from vomiting, diarrhea, and peri-umbilical pain to serious complications such as intussusception and gastrointestinal hemorrhage. Case presentation We report the case of a 7-year-old Caucasian girl who presented with abdominal pain, labial swelling, and a large abdominal ecchymosis two weeks after having been diagnosed with Henoch-Schönlein purpura. A computed tomography scan revealed abdominal wall edema extending to the groin, without any intra-abdominal pathology. She was successfully treated with intravenous steroids. Conclusion Circumferential anterior abdominal wall edema and labial edema have never been reported previously, to the best of our knowledge, as a complication of Henoch-Schönlein purpura. These findings further contribute to the wide spectrum of manifestations of this disorder in the literature, aiding in its recognition and management.
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Caliskan B, Guven A, Atabek C, Gok F, Demirbag S, Surer I. Henoch-Schönlein purpura presenting with symptoms mimicking balanoposthitis. Pediatr Rep 2009; 1:e5. [PMID: 21589821 PMCID: PMC3096029 DOI: 10.4081/pr.2009.e5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Accepted: 10/14/2009] [Indexed: 11/22/2022] Open
Abstract
Henoch-Schönlein purpura is a leukocytoclastic vasculitis, characterized with palpable purpuric rush and collection of immunglobuline A (Ig A) around small vessels. Onset of purpuric rush at gluteus and lower extremities is the main symptom of the disease, however it presents with a wide variety of signs and symptoms. Here, we present a two-year-old boy who had presented with penile swelling and color change. Then, purpuric rush was occurred and it was seen spontenous resolution on second day without treatment.
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Affiliation(s)
- Bahadir Caliskan
- Department of Pediatric Surgery, Gülhane Military Medical Academy, Ankara, Turkey
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Ferrara P, Marrone G, Nicoletti A, Mastrangelo A, Tiberi E, Rigante D, Stabile A. Penile involvement in Henoch-Schönlein purpura with good prognosis. ACTA ACUST UNITED AC 2008; 41:567-9. [PMID: 17853026 DOI: 10.1080/00365590701365487] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Henoch-Schönlein purpura (HSP), the commonest vasculitis in children, occurs most frequently between the ages of 4 and 6 years. We report the case of a 3-year-old boy with an otomastoiditis who was treated with cephalosporin and corticosteroids following a typical purpuric skin rash diagnosed as HSP. The patient also developed an acute occurrence of impairment of the glans, prepuce and penis 4 days after recovery that completely disappeared after a further 2 days, with the cutaneous rash subsiding on discharge from hospital.
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Affiliation(s)
- Pietro Ferrara
- Department of Pediatric Sciences, Università Cattolica S. Cuore, A. Gemelli Hospital, Campus Bio-Medico University, Rome, Italy.
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Luis GE, Ng ES. Acute compartment syndrome of the hand in Henoch-Schonlein Purpura. J Med Case Rep 2007; 1:6. [PMID: 17411454 PMCID: PMC1847827 DOI: 10.1186/1752-1947-1-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2006] [Accepted: 03/02/2007] [Indexed: 11/17/2022] Open
Abstract
An eight year old boy with Henoch-Schonlein Purpura (HSP) presented with acute compartment syndrome (ACS) of his left hand following arterial cannulation of his radial artery in intensive care unit. Emergency decompression and fasciotomy were performed. The authors report this first case in literature and discuss how HSP can be complicated by ACS and ways to prevent the latter from happening.
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Affiliation(s)
- Guntur E Luis
- Department of Orthopedics Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Eng-Seng Ng
- Department of Orthopedics Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Jequier M, Thurler-Thiele F, Lepori D, Gehri M. [Radiological quiz of the month. A case of a swollen and painful testis in a child]. Arch Pediatr 2005; 12:1513-4, 1500. [PMID: 16122918 DOI: 10.1016/j.arcped.2005.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2005] [Accepted: 06/30/2005] [Indexed: 11/17/2022]
Affiliation(s)
- M Jequier
- Département médico-chirurgical de pédiatrie, hôpital de l'Enfance de Lausanne, ch. de Montétan 16, 1000 Lausanne 7, Suisse
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Abstract
BACKGROUND/PURPOSE The aim of this study was to present the current experience and evidence relating to surgical evaluation and management of nonrenal genitourinary presentation in children with Henoch-Schönlein purpura (HSP). Henoch-Schönlein purpura is the most common systemic vasculitis in childhood. Presenting symptoms include a rash, arthralgia, abdominal pain, and, frequently, renal involvement. Genitourinary symptoms are infrequently reported; however, surgical evaluation is often required. METHODS A MEDLINE literature search of the last 3 decades was conducted using the terms Henoch-Schönlein purpura in combination with acute scrotum or genitourinary, genital, or related symptoms as the keywords. Reference lists of retrieved articles were reviewed for further relevant articles. Case reports were included when no larger case series were found. Articles of foreign language were included if abstracts proved sufficient information. RESULTS Genitourinary manifestations are mainly anecdotally reported. Scrotal pain and swelling were the most frequent nonrenal genitourinary symptoms reported in children with HSP, occurring in about 13% of boys evaluated for HSP. No prospective, population-based reports on genitourinary manifestations in HSP were found, thus making estimation of the true incidence difficult. CONCLUSIONS A wide variety of nonrenal genitourinary pathology may be expected by surgical evaluation of patients with HSP. Most cases are self-limited in nature. Scrotal symptoms are frequent, but testicular torsion is highly unlikely when the diagnosis of HSP is established. Clinical vigilance should be paid to patients with possible obstructive ureteritis, for whom prompt surgical intervention may be indicated.
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Affiliation(s)
- Kjetil Søreide
- Department of Surgery, Stavanger University Hospital, N-4068 Stavanger, Norway.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to educate the reader about the one of the most common vasculitides of childhood: Henoch-Schonlein purpura. Although the disease has been described for over a century, the etiology has yet to be discovered. Adult-onset Henoch-Schonlein purpura is unusual, but through case studies, this review examines some of the common manifestations of this presentation of disease. Long-term outcome studies are still defining how this disease affects a small but significant percentage of patients afflicted with Henoch-Schonlein purpura. RECENT FINDINGS This article will summarize recent work in molecular biology and genetics evaluating predisposing factors in the development of Henoch-Schonlein purpura. Further illustrations of the various complications of Henoch-Schonlein purpura will be reviewed. Recent long-term studies of outcomes of patients with renal disease from Henoch-Schonlein purpura will be summarized. SUMMARY After reading this review, the clinician will be able to elucidate the manifestations of Henoch-Schonlein purpura, determine appropriate treatment of the disease, and, most importantly, give the patient information about long-term consequences of Henoch-Schonlein purpura.
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Affiliation(s)
- Susan Ballinger
- Indiana University School of Medicine, Indianapolis 46202, USA.
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