Henoch-Schonlein purpura syndrome

[Summary]
Henoch-Schonlein purpura syndrome (Allergic Purpura Syndrome) called Schonlein-Henoch purpura, poisoning of hemorrhagic telangiectasia (Hemorrhagic Capillary Toxicosis) is the result of microvascular caused by the abnormal bleeding systemic disease, involving the skin, joints, gastrointestinal tract and kidney corresponding symptoms. The disease is found mostly in children and adolescents.
[Diagnosis]
According to the upper respiratory tract infection, skin purpura, as well as joints, abdomen, and the performance of renal involvement at the same time, there are recurrent characteristics, should consider the possibility of this disease. It should be noted, and idiopathic thrombocytopenic purpura, acute abdomen, glomerulonephritis, rheumatoid arthritis were identified.
[Treatment]
1. Remove causes include: anti-infection, remove Ganranzao to remove intestinal parasites, avoid application of the food and drug allergies. 2. Antihistamine drugs: the choice of chlorpheniramine, promethazine, diphenhydramine, such as drug Astemizole oral or intramuscular injection. 10% could also be applied to calcium gluconate 10 ml intravenous injection, 1 to 2 times daily.
3. Glucocorticoid: acute phase and applied to the abdomen, joint pain obviously, can rapidly relieve symptoms. Oral prednisone may be given, if necessary, hydrocortisone infusion. Short-term treatment (3-5) can ease the symptoms of withdrawal, but takes a longer time to medication should be gradual reduction after withdrawal.
4. Other: the acute phase should be bed rest, gastrointestinal symptoms should be fasting. High dose intravenous vitamin C (3 ~ 5g / day). Abdominal pain can be intense intramuscular injection of 0.5 to 1 mg of atropine. Bleeding tendency can be used to stop bleeding drugs. Have kidney damage.
[Etiology:
Not out of this disease may be related to a variety of factors, ① infection, the disease often in acute infection, and after a certain period of morbidity, more acute upper respiratory tract infection, pathogens to hemolytic streptococcus mainly, but also for the Staphylococcus aureus, viruses, and parasitic infections, ② food allergy, such as fish, shrimp, crab, such as homologous protein milk allergy can be induced by the disease, ③ drugs, such as Green streptomycin, sulfonamides, salicylic acid Preparations such. It was also possible the cold, insect bites, such as pollen dust exposure factors. These factors on the body as small arteries, veins and capillaries on the walls of the inflammatory change, increased vascular permeability caused subcutaneous tissue, and organ mucosal vascular leakage bleeding edema, and corresponding clinical manifestations.
[Pathological changes:
Blood and skin around the infiltration of lymphocytes and plasma cells, dermal layer of capillary was inflammatory changes, exudative, edema, hemorrhage, and cause skin purpura. Intestinal mucous layer edema, exudative, bleeding and abdominal pain are the reasons for the cause. And joint pain due mainly around the joint edema, caused by intra-articular effusion. Renal involvement that glomerular cell proliferation, necrotic foci with capillary thrombosis, renal tubular epithelial cells can also be found swelling, degeneration, fibrosis.
[Clinical]
1 ~ onset three weeks before there are upper respiratory tract infection, the slow onset, duration protracted, often alternating attack and mitigation, according to different parts of the lesion, and there are different clinical manifestations:
1. Cutaneous manifestations: a majority for the first symptom of skin purpura. Often seen in the distal limb extensor side of hip back, and face and trunk rare Purpura was distributed symmetrically, in batches, sizes, and integration into films, or even bleeding herpes and hemorrhagic necrosis. Purpura general a few days can be dissipated on its own. Can be accompanied by a small number of eyelids, lips, hand, foot and part of vascular edema or urticaria.
2. Gastrointestinal change: more skin purpura after abdominal symptoms, but also in gastrointestinal symptoms, as the first. Mainly for the onset of Changjiaotong, or continuing Duntong in Qizhou or lower abdomen, accompanied by nausea and vomiting, blood in the stool appear, hematemesis, intussusception and intestinal perforation. Investigations have tenderness in the abdomen, but no muscle tension and anti-Tiaotong. If abdominal symptoms as the main performance, known as abdominal Henoch-Schonlein Purpura (Henoch Purpura).
3. Joint performance: the performance of joint swelling limbs pain to the knee, ankle, elbow, wrist, etc. The most common, and often walk of a few days dissipated, can be repeated attacks, often accompanied by fever attack. To highlight the performance of joint symptoms, known as joint-Henoch-Schonlein Purpura (Schonlein Purpura).
4. Kidney performance: kidney Purpura change often followed showed proteinuria, hematuria, and urinary tube, and some patients may be associated with edema, oliguria and hypertension. Under normal circumstances the disease better resume kidney damage, leaving aftermath, a few may be turned into a chronic nephritis, or uremia. It should be noted mainly occasionally to kidney disease are not obvious and Purpura performance.
Exudative other vascular hemorrhage and edema can also affect the nervous system, respiratory tract, and other corresponding symptoms.
[Auxiliary]
Bleeding time and coagulation time, and normal platelet count, erythrocyte sedimentation rate may be normal or mildly by fast. Some patients capillary fragility test (beam arm test) positive. Renal involvement may have proteinuria, hematuria, and urinary tube.