Henoch-Schonlein Purpura Successfully Treated with Oral Steroids: A Case Report

A 38-years old male patient, documented case of Irritable Bowel Syndrome (IBS), presented to the clinic with complaints of severe central abdominal pain and severe rash. The day before presenting to the clinic, the patient went to the Emergency Department for the same complaints.

According to the patient, the abdominal pain was colicky in nature. There were no associated complaints of nausea, vomiting, or GI bleeding, but did have an upper respiratory tract infection three weeks ago, after which he had started experiencing these symptoms. His infection was treated with oral antibiotics and was soon got resolved. The staff at the ED had investigated the cause, including a CT abdomen with contrast, but the reports had been all clear. He had mildly raised serum creatinine at that time.

On clinical examination, the patient had severe tenderness in his abdominal region. The rash was extensive, reddish, raised, and purpuric in nature and had spread all over his lower limbs and hips on both sides. The upper limbs were also involved up to the forearms.

All the lab investigations conducted on the patient were normal, including CBC, Creatinine, Serum C3, C4, and the rheumatoid factor. CRP was found to be elevated and positive occult blood was seen in the stool of the patient.

The combination of the above medical symptoms and investigations revealed that the patient was suffering from abdominal angina. The symptoms had a classic presentation pattern: positive occult blood in stool, a purpuric rash, abdominal pain, and renal involvement that was preceded by a documented case of upper respiratory tract infection (URTI).

Later, the patient was found to have all findings consistent with immune-mediated IgA vasculitis (Henoch Schonlein Purpura) and was then treated accordingly.

The above-mentioned case was an interesting presentation: the condition is not often presented to the hospital with such clear manifestations, leading to an absolute diagnosis. The following sections of this case study will explore how the patient was diagnosed, treated, and managed accordingly to save his life.