March 22, 2023


Thank you welcome to atcm the emergency medicine channel today let us discuss about one important skin disease that is enough shown in purple it’s not actually skin disease it’s a purpuric rash all over the lower limbs mainly in the lower limbs and sometimes it can lead to internal organ problems like renal damage can occur other immune mediated complications can

Occur but that all rare but commonly it present as purple we know that purpura can be due to various conditions purpura can be due to vasculitis can be due to ah thrombocytopenia purpura can be due to infections in that immune mediated purpose that is vasculating purpose or palpable purpura that is a main differentiation between other types of purple especially

Thrombocytopenic purpira to vascular vascular purpurea or or we always palpable purpose you can palpate over the skin it’s a immune mediated immune complex mediated small vessel vasculitis especially in the skins mainly in the lower limbs it is an iga mediated vasculitis so it is otherwise called as iga vasculitis previously it was known as hen of chandler

And barbara both names we can use it’s a form of leukocytoklastic vasculitis if you take a biopsy from the skin most of the time the pathologist may report it has leukocytoplastic vasculitis it is characterized by inflammation and crossing involving small vessels predominantly post capillary venules capillaries arterioles so mostly it will be confined to the

Skin rarely it produces internal organ damage especially kidney damage can occur in rare conditions it can also involve ga tract kidneys joints lungs and other areas that is very very rare disease is very benign in children mostly it is seen in children only but in them they are either disease is benign but when it occurs in adults sometimes it can produce

Complications like internal organ complication can occur most of these children may have a trigger that is an upper respiratory tract infection one to two weeks prior to the skin lesions many patients can have prodromal symptoms like headache anorexia feverish feeling all these things then patient develops rashes mainly that rashes are seen in the lower limbs

They are palpable rashes 90 to 100 percent of the cases these rashes are seen abdominal pain and vomiting can be there in many patients 35 to 85 percent of the patients this is seen joint pains 60 to 84 percent you can get especially knees knee joint and ankle joints you can get joint pains some patients kind of subcutaneous edema scrotal edema and blood in the

Stools so these abnormal findings like abdominal pain joint pains ah generalized edema blood in stools or shows some ah like complication internal organ complications so we have to be very careful when we are dealing such patients you can see here patient can have lower limb pulpable purpura mainly in the calf areas patient can also have papyrus above that also

In the luteal area thigh area rarely it goes to the upper part of the body so this is a classical condition where you get palpable purpuras in the lower limb in children now some patients can have abdominal pain bleeding diarrhea arthritis all these things we have seen 30 to 50 percent of the children can have acute glomerulo nephritis they can present with

Hematuria hypertension abdominal abnormal renal function tests like elevated creatine urea some can have proteinory also colicky abdominal pain is seen in many patients rarely some patients can have bleeding per rectum or a melina in this reception can develop in some children occult blood can be positive in many children upper respiratory attract infection can

Occur prior to the skin lesions it can be due to streptovocal infection also remember streptococcal infection itself can produce skin lesion that is scarlet fever you can see many other infections also can have upper respiratory infection with the generalized rashes adult onset stills disease can have same problem like sore throat then fever rashes so there are a

Lot of differential diagonals for this type of diseases but fortunately this disease is a benign disease and the lesions are mainly confined to the lower limb but rarely this disease can become problematic chronic disc kidney disease can develop in patients who are adults and who develop ah type of escalatis kidneys are rarely involved in this type of condition

Especially in adults so you can think about this disease by remembering ah this mnemonic his past amateuria idea related vasculitis small childrens are commonly affected skin purple recollections in the lower limb they are palpable purpuras proteinuria abdominal pain arthritis structural sore throat is common trigger for this disease we can see the investigation

Patient like blood test we can do complete blood count we have to rule out thrombocytopenia because thrombocytopene is one of the major cause for a purpuric rashes but that purpose crashes are mainly in the trunk upper limb and wherever we are tying bb apparatus bp cuff that areas this are very common but here patient is having only lower limb papyrus very rarely

Upper limb and trunk will be involved ptnr should be done because any bleeding tendency any purpura we had always check ptn are repetitive platelet count renal function tests very rarely this hsp can lead to kidney disorders complement level should be done sometimes complements can be low if since it is a complement mutated attack serum iga levels are elevated

In 50 to 70 percent of the patients with the iga vasculitis higher levels are associated with renal involvement so you can see here one of the easiest thing easiest investigation ah which is available to diagnose inox online purpurizer local skin biopsy skin biopsy may show it as a leukocytoklastic vasculitis of small vessels so skin lesions should be taken for

Biopsy and that will give a diagnose of iga deposits in small vessels in the skin viewed by the immunofluorocin microscopy and inflammation of small vessels in the skin now once the kidneys are involved we are to do some investigation like creatinine urea complement levels low complement levels are classically since since it is a compliment mediated injury kidney

Biopsy may show mild miss angel proliferation to crescentric glomerularonephritis that should be done if there is a elevated urea creatine level or persistent proteinuria management is very very simple because most of these conditions are benign we no need to give any treatment without any major treatment itself this may subside but remember some children and

Some adults this may not come down without any major treatment now most of the patients treatment is not required you can treat with only supportive therapy ah you can give paracetamol or some skin soothening agents but those who having like persistent disease we have to give butness around one milligram per kg body weight for a short period then discontinuate

But in adults sometimes it can persistent so that we have to add steroid sparing agents like acetylene 50 milligram once dairy some patients may require cyclophosphate cyclo sporing patients who is persistent protein area should be started on ac inhibitors or arb in concert losartan candidates are ubisoft and whatever track we prefer you can give they can reduce

The protein area diperidder model or aspirin paracetam aspirin or product can be given in patients who is a persistent kidney damage high dose ivig should be given in patients moving acute problem like acute kidney injury there we can use ah ibig dinosaur fish oil all are supportive therapy so we have discussed about one of the ah important benign condition that

Is inox online purpura ah but it can present as thrombocytopenia to emergency room they can have severe abdominal pain sometimes they can have a peripheral purpuric rashes all over the body and most of the time this purpuric rashes can be confined to lower limb in a in majority of the patient but some patients can have generalized it has got lot of differential

Diagnosis it can be due to thrombocytopenia it can be due to adult onset stills disease it can be due to meaning of oxymia so so many differential diagonals for this type of diseases so it is ah better to know about this disease so that without any major treatment itself patient may improve but whereas other conditions like a thrombocytopenia or adult onset of

Shields disease or meningocoxima require ah very aggressive treatment so the knowledge about this type of benign differential diagnosis for purpureas are also very very important thank you

Transcribed from video
Henoch-Schönlein Purpura|| HSP By AETCM Emergency Medicine