Severe Disfiguring Scalp and Facial Oedema due to Henoch–Schönlein Purpura in a Child

Abstract

Henoch–Schönlein purpura is a small vessel vasculitis that usually presents with palpable purpura, arthritis, abdominal pain, and nephritis. Subcutaneous oedema of dependent areas is common; however, oedema in the scalp is extremely rare especially in children older than two years. Here, we report a child with massive disfiguring scalp and facial oedema due to Henoch–Schönlein purpura. An eight-year-old boy presented with characteristic palpable purpuric rash and extensive disfiguring scalp and facial swelling for five days. He complained of blurred vision, vomiting, and severe headache on the day of admission. Examination revealed an ill child with extensive oedema of the face and scalp that was tender on palpation. His blood pressure was above the 99th percentile, and he had exaggerated deep tendon reflexes and extensor plantar responses. All biochemical investigations including renal function tests were normal. Noncontrast CT head showed normal brain, with marked soft tissue swelling of the scalp. Ultrasonography showed soft tissue oedema within and surrounding facial muscles without evidence of neck vessel compression. Urine analysis revealed microscopic haematuria on day 14 of the illness, and immunohistochemical staining of renal biopsy confirmed Henoch–Schönlein purpura nephritis. In conclusion, this case report presents a child with severe, disfiguring scalp and facial oedema due to Henoch–Schönlein purpura. It highlights that severe subcutaneous oedema of Henoch–Schönlein purpura can involve any part of the body not limiting to dependent areas.

Immunoglobulin‐A vasculitis manifesting as edema in the scalp, face, and sternocleidomastoid muscle

“…1 Increased intravascular pressure owing to hypertension in IgAV may also contribute to extravasation. 4 Angioedema may be another cause of subcutaneous edema in IgAV. In a retrospective study of 2371 cases of IgAV in children, 25.7% have been reported to experience angioedema.…”

“…While rare in adults, it has been occasionally reported in children, especially under 2 years of age. [2][3][4] This is probably because the blood supply to the scalp and face is greater in infants owing to their larger body surface. In our case, we believe that the edema of the scalp, face, and sternocleidomastoid muscle was related to IgAV.…”

Risk factors of renal trauma in children with severe Henoch-Schonlein purpura and effect of mycophenolate mofetil on pediatric renal function

“…The inclusion criteria of the study were as follows: (I) the child or their family members fully understood the study process and signed the informed consent; (II) the child was diagnosed with severe HSP for the first time (9); (III) the child presented clinical symptoms such as purpura of lower limbs and abdominal pain (10,11); and (IV) the child had stable vital signs.…”

Edema frontal como primer signo en púrpura de Henoch-Schönlein

“…El edema subcutáneo, especialmente en las extremidades inferiores, es un hallazgo común en pacientes con PHS. Sin embargo, el edema local en el cuero cabelludo como manifestación de la PHS es muy infrecuente y se observa principalmente en niños menores de 2 años 1 , 2 , 3 . El edema subcutáneo en pacientes con PHS probablemente se debe a una fuga de fluido resultante de la inflamación vascular.…”