By vgreene, 5 June, 2017

DM

(BMJ)—A 53-yo woman presented w/ a 2-wk hx of rash on her legs that had progressed up to her arms. She also complained of pain in her wrists, knees, and elbows. She had group A strep pharyngitis ≈5mo earlier that was not treated w/ abx. Exam: afebrile; petechiae and palpable purpura. Meds: albuterol, famciclovir, levothyroxine, lovastatin, varenicline. CBC and coagulation panel WNL. UA: (+)blood, (+)protein. What is the dx?
Rocky Mountain spotted fever
Wegener granulomatosis
Thrombotic thrombocytopenic purpura
Henoch-Schönlein purpura
Hypersensitivity vasculitis
You are correct. She met the clinical criteria for Henoch-Schönlein purpura (HSP)—palpable purpura in the presence of either diffuse abdo pain, predominant IgA deposition, arthritis/arthralgia, or renal involvement. Skin and kidney biopsies confirmed predominant IgA deposition. Although more common in children, HSP can occur in adults. HSP may be triggered by an infection, particularly group A strep, C difficile, H pylori, and others. Eval should focus on ruling out other causes of vasculitis. This pt was treated w/ prednisolone, and her skin lesions rapidly improved. However, she developed HTN and hyperglycemia, probably as a result of steroid tx. Prednisolone dose was lowered, and insulin was started. Her BP and blood glucose subsequently improved. At f/u, her hematuria and proteinuria had resolved, and systemic steroids were gradually reduced.

BMJ 2009;338:b1284