Henoch-Schönlein purpura from vasculitis to intestinal perforation: A case report and literature review

Table 1 Summaries of clinical data, investigations, and treatment in this case report

Category	D1-3	D5	D6	D7	D12	D14	D17	D31
	8-10/1/15	12/1/15	13/1/15	14/1/15	19/1/15	21/1/15	24/1/15	7/2/15
	Private hospital			This hospital
Symptoms	Intermittent abdominal pain, purpuric rash	Abdominal pain progressed	Seizure	Regained consciousness, abdominal pain improved, purpura faded away	Abdominal pain progressed	Persistent abdominal pain with hematochezia	Low grade fever, severe abdominal pain	No abdominal pain, normal appetite
Abdominal signs	Soft, mild tenderness	Generalized voluntary guarding		Soft, not tender	Localized guarding and tenderness at RLQ	Localized guarding and tenderness at RLQ	Distend, generalized guarding	Soft, not tender
Investigations		US - no intussuscep-tion	Hyponatremia MRI/MRA - no vasculitis, CSF fluid - normal	Normal EEG	US - Diffuse small bowel wall thickening, minimal ascites, no intussuscep-tion	Radiograph - no free air, CT - bowel wall thickening, normal homogeneous enhancement	Radiograph - intraperitoneal free air
IVMP (mg/kg/d)	2	1	30	2	2	2	2	Switch to oral prednisolone
Treatment		Nexium, sucralfate	ET tube, 3% NaCl, Keppra, Refer	Extubation, off Keppra	NPO, IVIG 2 gm/kg/dose	NPO	NPO, ATB, exploratory laparotomy

RLQ: Right lower quadrant; US: Ultrasonography; CT: Computerized tomography; EEG: Electroencephalogram; IVIG: Intravenous immunoglobulin; IVMP: Intravenous methylprednisolone; NPO: Nothing by mouth; ATB: Antibiotic; ET: Endotrachial; NaCl: Sodium chloride.