Lumbar Swelling as the Unusual Presentation of Henoch-Schonlein Purpura in a Child

Abstract

Background: Henoch-Schönlein Purpura (HSP) is a systemic hypersensitivity disease of unknown cause that is characterized by a purpuric rash and systemic manifestations, such as colicky abdominal pain, polyarthralgia, and acute glomerulonephritis. Common complications of HSP that lead to surgical intervention include intussusception, perforation, necrosis, and massive gastrointestinal bleeding. Unusual clinical manifestations of HSP may include edema of the scrotum and eyes. Lumbar swelling is rarely seen as a complication of HSP. Case Report: A four-year-old boy was admitted to our emergency room with a 7 day history of increasing abdominal pain. Within 48 hours of admission, erythematous macules and palpable purpuric lesions developed on the lower extremities. On the third day of hospitalization, sudden onset of severe back pain, swelling on the lumbar region and refusal to walk were seen. On the fifth day, lumbosacral edema and pain resolved but facial edema developed. He was diagnosed clinically with HSP. Conclusion: To the best of our knowledge, only a few cases of HSP with lumbar edema have been reported so far. If the first clinical symptoms of HSP are atypical, clinical progress can be atypical, too.

Keywords

• Abdominal pain, Henoch Schonlein purpura, lumbar swelling, vasculitis, facial edema

References

1. 1. Weiss PF. Pediatric vasculitis. Pediatr Clin North Am 2012;59:407-23. [CrossRef]
2. 2. Schaefer B, Soprano C. Five-year-old boy presenting with severe back pain, swelling, and refusal to walk. Clin Pediatr (Phila) 2014;53:95-7. [CrossRef]
3. 3. Anil M, Aksu N, Kara OD, Bal A, Anil AB, Yavaşcan O, et al. Henoch-Schönlein purpura in children from western Turkey: a retrospective analysis of 430 cases. Turk J Pediatr 2009;51:429-36.
4. 4. Mills JA, Michel BA, Bloch DA, Calabrese LH, Hunder GG, Arend WP, et al. The American College of Rheumatology 1990 criteria for the classification of Henoch-Schönlein purpura. Arthritis Rheum 1990;33:1114-21. [CrossRef]
5. 5. Ozen S, Pistorio A, Lusan SM, Bakkaloglu A, Herlin T, Brik R, et al; Pediatric Rheumatology International Trials Organisation (PRINTO). EULAR/PRINTO/PRES criteria for HenochSchönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteria. Ann Rheum Dis 2010;69:798-806. [CrossRef]
6. 6. Hung TY, Liu MC, Hsu CF, Lin YC. Facial edema as the initial presentation of Henoch-Schonlein purpura in a 5-year-old boy. Pediatr Emerg Care 2009;25:31-2.[CrossRef]
7. 7. Ceyhan M. Scalp and facial edema preceding Schönlein-Henoch syndrome by 28 days. Pediatr Dermatol 1992;9:311. [CrossRef]
8. 8. Güneş M, Kaya C, Koca O, Keles MO, Karaman MI. Acute scrotum in Henoch-Schönlein purpura: fact or fiction? Turk J Pediatr 2012;54:194-7.

9. 9. 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. [CrossRef]
10. 10. Nussinovitch M, Prais D, Finkelstein Y, Varsano I. Cutaneous manifestations of Henoch-Schönlein purpura in young children. Pediatr Dermatol 1998;15:426-8. [CrossRef]