Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 16, 2023; 11(26): 6311-6317
Published online Sep 16, 2023. doi: 10.12998/wjcc.v11.i26.6311
Delayed diagnosis of abdominal Henoch-Schonlein purpura in children: A case report
Hui Guo, Zhi-Ling Wang, Zhu Tao
Hui Guo, Department of Pediatrics, West China Second University Hospital, Chengdu 610041, Sichuan Province, China
Zhi-Ling Wang, Zhu Tao, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu 610000, Sichuan Province, China
Author contributions: Wang ZL analyzed and interpreted the patient data regarding the Henoch-Schonlein purpura and was a major contributor in writing the manuscript; Tao Z collect related literature and complete partial manuscript content; Guo H revised and expanded the manuscript. All authors read and approved the final manuscript.
Supported by the Science and Technology Bureau of Sichuan province, No. 21ZDYF1329.
Informed consent statement: Informed written consent was obtained from the patient’ family for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hui Guo, MD, Doctor, Department of Pediatrics, West China Second University Hospital, No. 20 Section 3, Renmin South Road, Chengdu 610041, Sichuan Province, China. guohui0329@163.com
Received: July 10, 2023
Peer-review started: July 10, 2023
First decision: July 23, 2023
Revised: August 11, 2023
Article in press: August 11, 2023
Published online: September 16, 2023
Processing time: 59 Days and 23.7 Hours
Abstract
BACKGROUND

For children with abdominal Henoch-Schonlein purpura presenting abdominal pain as an initial symptom and severe clinical manifestations, but without purpura appearance on the skin, the diagnosis and treatment are relatively difficult. This study summarized the characteristics of this group of patients by literature review and provided additional references for further refinement of glucocorticoid therapy in this vasculitis.

CASE SUMMARY

A 6-year-old girl presented mainly with repeated abdominal pain and had received short-term out-of-hospital treatment with hydrocortisone. On day 7 after onset, gastroscopy revealed chronic non-atrophic gastritis and erosive duodenitis without purpuric rash, and no obvious resolution of the abdominal pain was found after treatment against infection and for protection of gastric mucosa. On day 14 the inflammatory indices continued to rise and the pain was relieved after enhanced anti-infective therapy, but without complete resolution. On day 19, the patient presented with aggravated abdominal pain with purplish-red dots on the lower limbs, by which Henoch-Schonlein purpura was confirmed. After 5 d of sequential treatment with methylprednisolone and prednisone, abdominal pain disappeared and she was discharged.

CONCLUSION

Henoch-Schonlein purpura-related rash may appear after long-term abdominal pain, and should be distinguished from acute and chronic gastrointestinal diseases at the early stage without typical rash. For bacterial infection-induced Henoch-Schonlein purpura, glucocorticoid therapy alone without clearing the infection may not relieve symptoms.

Keywords: Henoch-Schonlein purpura; Delayed diagnosis; Rash; Abdominal pain; Gastrointestinal disease; Case report

Core Tip: Henoch-Schonlein purpura (HSP) is a common vasculitis in children. Abdominal pain is one of its characteristic features, but the presence of gastrointestinal symptoms alone without a rash is easily misdiagnosed. We report a case of HSP with abdominal pain as the first symptom, emphasizing the importance of differential diagnosis to avoid incorrect surgery.