From the Research
For a child presenting to the Emergency Department with a suspicious rash concerning for Henoch-Schönlein Purpura (HSP), the workup should include a comprehensive assessment focusing on both diagnosis and potential complications, as outlined in the most recent review of HSP in children 1. The diagnosis of HSP is primarily clinical, based on the presence of palpable purpura and at least one of the following criteria: diffuse abdominal pain, arthritis or arthralgia, renal involvement (hematuria and/or proteinuria), and a biopsy showing predominant IgA deposition. Key components of the workup include:
- Complete blood count
- Urinalysis to assess for hematuria or proteinuria, which may indicate renal involvement
- Basic metabolic panel
- Coagulation studies (PT/PTT)
- Blood pressure measurements, as hypertension can be present with renal involvement
- Inflammatory markers like ESR and CRP, which are often elevated in HSP
- Abdominal imaging (ultrasound) if the patient has significant abdominal pain to rule out intussusception, a potential complication
- Documentation of the distribution and appearance of the rash, typically palpable purpura on the lower extremities and buttocks These tests help confirm HSP diagnosis and identify organ involvement, particularly renal and gastrointestinal, which may require more aggressive management or admission, as noted in a review of HSP diagnosis and classification 2. It's also important to consider the potential for long-term complications, such as persistent hypertension and end-stage kidney disease, and the need for follow-up care, as discussed in a study on the management of HSP 3 and a review of HSP in children 1. The use of corticosteroids in the treatment of HSP is not universally recommended, but may be considered in cases with severe gastrointestinal pain and gastrointestinal hemorrhage, or in patients with severe nephritis or renal involvement with proteinuria of greater than 3 months, as noted in a review of HSP treatment 1. Overall, the goal of the workup is to confirm the diagnosis of HSP, identify potential complications, and guide management to minimize morbidity and mortality, as emphasized in a study on the diagnosis and management of HSP 4.