MEDizzy - An 8-year-old girl presents with fever and a rash on her

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Hematology

An 8-year-old girl presents with fever and a rash on her legs that developed approximately 2 weeks after she recovered from a sore throat. During this time she also had intermittent pain in her abdomen and her knees and ankles. Physical examination finds multiple hemorrhagic lesions on her legs each measuring about 5 mm in diameter. Palpable lesions were felt below some of these areas of hemorrhage, but they did not blanch when pressure was applied. Laboratory examination finds an elevated erythrocyte sedimentation rate. Which one of the listed conditions should be considered most likely in the differential diagnosis?

ExplanationPurpura, arthritis, and abdominal pain in a child are the classic triad of clinical signs of Henoch-Schönlein purpura. This disease, also known as anaphylactoid or allergic purpura, is a type of hypersensitivity vasculitis found in children. It usually develops 1 to 3 weeks following a streptococcal infection, but it may also occur in relation to allergic food reactions. Crossreacting IgA or immune complexes are deposited on the endothelium of blood vessels. About one-third of patients with Henoch-Schönlein purpura will develop kidney involvement leading to several different abnormalities that include gross or microscopic hematuria, proteinuria, and the nephrotic syndrome.