Unknown 155

1
Unknown 155
2

• 18 yo male presents with 3 weeks h/o hematuria
  and joint pains in his ankles, knees and hips.
  The joint pains would resolve in one set of
  joints before moving to the next set.
• The patient notes that he was treated for a strep
  throat in the weeks before his current symptoms
  began.
• The patient is found to have creatinine of 1.9,
  and 2 proteinuria. CBC and coags are wnl.

3
Buttock and thigh
4

• What would a renal biopsy likely show?
• Normal
• Membranous nephropathy
• Leukocytoclastic vasculitis accompanied by IgA
  immune complexes
• Lupus nephritis
• Extensive crescent formation

5

• What would a renal biopsy likely show?
• Normal
• Membranous nephropathy
• Leukocytoclastic vasculitis accompanied by IgA
  immune complexes
• Lupus nephritis
• Extensive crescent formation

6
Leukocytoclastic vasculitis accompanied by IgA
immune complexes

• Henoch-Schönlein purpura (HSP) is the most common
  form of systemic vasculitis in children. Ninety
  percent of cases occur in the pediatric age
  group. In contrast to many other forms of
  systemic vasculitis, HSP is self-limited in the
  great majority of cases.

7

• The disease is characterized by a tetrad of
  clinical manifestations
• 1. Palpable purpura in patients with neither
  thrombocytopenia nor coagulopathy
• 2. Arthritis/arthralgia
• 3. Abdominal pain
• 4. Renal disease

8

• HSP is an immune-mediated vasculitis associated
  with immunoglobulin A (IgA) deposition. Although
  a variety of infectious and chemical triggers
  have been proposed, the underlying cause of HSP
  remains unknown.
• Occurs primarily between the ages of 3 and 15
  years. The annual incidence is 10 to 20 per
  100,000 in children lt17 years of age with a peak
  incidence in children between 4 to 6 years of
  age. Approximately, 10 percent of HSP cases occur
  in adults

9

• The diagnosis of HSP is usually based upon
  clinical manifestations of the disease. In
  patients with an incomplete or unusual
  presentation, biopsy of the affected organ (eg,
  skin or kidney) demonstrating predominantly IgA
  deposition supports the diagnosis of HSP.

OBJECTIVE Evaluate suspected Henoch-Schönlein
purpura in an adolescent