A 7 yo M with no PMH and recent URI symptoms presents with purpuric rash of the lower extremities, colicky abdominal pain, and decreased appetite.
Questions to Ask
- Infectious?
- Fever?
- Other systemic involvement?
- Any easy bleeding/bruising?
Clinical Presentation & History
- Palpable purpuric rash affecting lower extremities, buttocks
- Periumbilical tenderness to palpation
- During evaluation, patient develops severe abdominal pain, which then improves in a few minutes.
- Joint pain but no arthritis on exam
Diagnostic Workup
- Recommended labs: CBC w/ diff, CMP, urinalysis
- Results unremarkable
- Recommended imaging: abdominal ultrasound
Treatment & Management
- Systemic steroids are indicated given abdominal pain (prednisone 1 m/kg per day with a taper over few weeks)
- Return precautions – monitor for:
- Severe and persistent abdominal pain
- Emesis
- Blood in stool
- Hematuria
- Monitor urinalysis and blood pressure monthly to ensure no progressive renal involvement