Clinical profile and outcome of Henoch Schonlein purpura in a tertiary care hospital in South India

Abstract

Background: Henoch Schonlein purpura (HSP) is the most common systemic vasculitis in children. It is an immunoglobulin A (IgA) mediated systemic small-vessel vasculitis, with IgA deposition in vessel walls leading to symptoms involving the skin, joints, intestines, and kidneys. The objective of present study was to identify and describe the clinical profile, pattern of joint involvement, histopathological features, treatment modalities and complications of Henoch Schonlein purpura.Methods: 52 children less than 12 years diagnosed to have Henoch Schonlein Purpura according to the European League against Rheumatism criteria were included in the study. All patients were subjected to detailed history taking and thorough examination. The clinical features, investigations, management and complications of the disease were studied. Descriptive statistics was used to analyse the results.Results: The common clinical features were palpable purpura (100%) followed by arthritis (66%) and abdominal pain (50%). Renal manifestations were in the form of hematuria in 12% of the patients. Skin biopsy was done in 25 patients of which 19 had findings suggestive of Henoch Schonlein purpura. Steroids were used in 42% of patients. The severity of illness was associated with lower mean age, arthritis, leg edema and stool occult blood.Conclusions: The clinical features of Henoch Schonlein purpura in the population were different from the previously published studies. Renal involvement was less common. The short-term outcome of the patients were satisfactory.

Henoch Schonlein Purpura in Children: Clinical Profile and Renal Involvement

“…There was near equal sex predilection in our study (1.06:1).Abbas et al from south India and Anil et al from Turkey also has noted similar sex ratio [5,11] . The reason for this difference in the male female ratio is not very clear.…”

“…The mean age of onset of symptoms was 7.84 years which is comparable to other studies [5][6][7][8] .Most of the studies of HSP all over the world had showed male predominance [7][8][9] . There was near equal sex predilection in our study (1.06:1).Abbas et al from south India and Anil et al from Turkey also has noted similar sex ratio [5,11] .…”

“…Lower occurrence of renal involvement is described by Abbas et al from South India and Sarkar et al from EasternIndia [5,15] Abbas et al study did not mention about follow up. So, there is a chance of missing of cases of late renal involvement which can occur up to 6 months.…”

Clinical Profile of Henoch-Schonlein Purpura in Children

“…Anaemia was seen in 48% of patients, raised ESR in 50% and thrombocytosis in 20%. In a study by Abbas et al, 13 anaemia was seen in 48%, raised ESR in 48% and thrombocytosis in 19% of patients. Stool occult blood was positive in 20% of patients, which was comparable to that in other studies.…”

“…Renal involvement in most studies ranged between 11% and 31%. 10,13 The low incidence of renal disease could be due to the retrospective nature of the study. Repeated urine analysis and follow-up may have detected more cases with minor renal involvement.…”