Subconjunctival hemorrhage in Henoch-Schonlein purpura: a case report and literature review

Year 2019, Volume: 11 Issue: 3, 349 - 352, 01.09.2019

Yaprak Akbulut , Nesrin Büyüktortop , Cihat Şanlı Erhan Yumuşak , Tevfik Oğurel

https://doi.org/10.21601/ortadogutipdergisi.453297

Abstract

We report a 5-year-old boy who presented with diffuse abdominal pain, non-thrombocytopenic purpuric skin rash, and bilateral multiple foci of subconjunctival hemorrhage in the inferior bulbar conjunctiva. The patient was diagnosed clinically with Henoch-Schonlein purpura (HSP), according to EULAR/PRINTO/PRES criteria.HSP is a leukocytoclastic small vessel vasculitis. Ocular involvement is very rare. Episcleritis, keratitis, uveitis, cystoid macular edema and cotton wool spots, central retinal artery occlusion, anterior ischemic optic neuropathy and subperiosteal hematoma were reported previously. Here, we present a case of bilateral subconjunctival hemorrhage in a child with HSP for the first time in the English literature.

Keywords

Henoch-Schonlein purpura, ocular, subconjunctival hemorrhage, vasculitis

Henoch-Schonlein purpurada subkonjonktival hemoraji: olgu sunumu ve literatür taraması

Abstract

Bu
yazıda diffüz abdominal ağrı, trombositopenik olmayan purpurik deri döküntüsü
ve inferior bulbar konjunktivada bilateral multipl subkonjonktival hemoraji ile
başvuran 5 yaşında bir erkek hasta sunuldu. Hastaya EULAR / PRINTO / PRES
kriterlerine göre klinik olarak Henoch-Schonlein purpurası (HSP) tanısı konuldu.
HSP bir lökositoklastik küçük damar vaskülitidir. Oküler tutulum çok nadirdir.
Episklerit, keratit, üveit, kistoid maküla ödemi ve atılmış pamuk manzarası ,
santral retinal arter tıkanıklığı, ön iskemik optik nöropati ve subperiosteal
hematom daha önce bildirilmiştir. Burada, İngiliz literatüründe ilk kez HSP'li
bir çocukta bilateral subkonjonktival hemoraji olgusunu sunuyoruz.

Keywords

Henoch-Schonlein purpura, oküler, subkonjonktival hemoraji, vaskülit

References

• Hetland LE, Susrud KS, Lindahl KH, Bygum A. Henoch-Schönlein purpura: a literature review. Acta Derm Venereol 2017; 97: 1160-6.
• Ozen S, Pistorio A, Iusan International Trials Organisation (PRINTO). EULAR/PRINTO/PRES criteria for Henoch-Schönlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis SM, et al. Paediatric Rheumatology and childhood Takayasu arteritis: Ankara 2008. Part II: Final classification criteria. Ann Rheum Dis 2010; 69: 798-806.
• Yamabe H, Ozawa K, Fukushi K, Kubota H, Ohsawa H, Akitsu H. IgA nephropathy and Henoch-Schönlein purpura nephritis with anterior uveitis. Nephron 1988; 50: 368-70.
• Muqit MM, Gallagher MJ, Gavin M, Roberts F, Jardine AG. Henoch-Schonlein purpura with keratitis and granulomatous anterior uveitis. Br J Ophthalmol 2005; 89: 1221-2.
• Erer B, Kamali S, Cingu K, et al. Recurrent anterior uveitis in Henoch Schonlein’s vasculitis. Rheumatol Int 2010; 30: 1377-79.
• Kaur S, Maheshwari A, Aneja S, et al. Henoch-Schönlein purpura with uveitis: an unusual case and review of literature. Rheumatol Int. 2012; 32: 4057-9.
• Nicholson L, Mathews D. Bilateral cystoid macular oedema and cotton wool spots associated with Henoch-Schonlein purpura. BMJ Case Rep 2013; 9: 200159.
• Patheja RS, Chidgey A. A rare case of bilateral cystoid macular oedema associated with decompensated Henoch-Schonlein purpura-related nephropathy. Clin Exp Ophthalmol 2016; 44: 209-12.
• Wu TT, Sheu SJ, Chou LC, Wu TT, Sheu SJ, Sheu SJ. Henoch-Schonlein purpura with bilateral central retinal artery occlusion. Br J Ophthalmol 2002; 86: 351-2.
• Ma’luf RN, Zein WM, El Dairi MA, Bashshur ZF.Bilateral subperiosteal orbital hematomas and Henoch-Schönlein purpura. Arch Ophthalmol 2002; 120: 1398-9.
• Chuah J, Meaney T. Anterior ischaemic optic neuropathy secondary to Henoch-Schönlein purpura. Eye (Lond) 2005; 19: 1028.
• Lorentz WB Jr, Weaver RG. Eye involvement in anaphylactoid purpura. Am J Dis Child 1980; 134: 524-525.
• Ryder HG, Marcus O. Henoch-Schönlein purpura: a case report. S Afr Med J 1976; 50: 2005-6.
• Tarlan B, Kiratli H. Subconjunctival hemorrhage: risk factors and potential indicators. Clin Ophthalmol 2013; 7: 1163-70.
• Weiss PF. Pediatric vasculitis. Pediatr Clin North Am 2012; 59: 407-23.