What are physical findings characteristic of Henoch-Schönlein purpura (IgA vasculitis)?

Updated: Jan 08, 2021
  • Author: Rajendra Bhimma, MBChB, MD, PhD, DCH (SA), FCP(Paeds)(SA), MMed(Natal); Chief Editor: Craig B Langman, MD  more...
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Answer

Because IgAV can affect all organ systems, a full physical examination is indicated. Physical findings may include the following:

  • Skin findings (usually the first sign of IgAV) - Erythematous, macular, or urticarial lesions, progressing to blanching papules and later to palpable purpura; typically, symmetrical and tending to be distributed in dependent body areas, such as the ankles and lower legs in older children and adults; the back and buttocks in toddlers; and the face, trunk, and upper extremities in young non-ambulant children. Hives, angioedema, and target lesions can also occur. The rash may be itchy but is rarely painful. Localized subcutaneous edema is a common feature especially in children < 3 years old, usually occurring in dependent and periorbital areas. In adults it usually involves the dorsum of the hands. Blistering eruptions may also occur. [2]  

  • Kidney findings - Hematuria, nephrotic syndrome; involvement of the kidneys may occur in 20-60% of cases, especially in older children and adults, and is the leading case of morbidity in IgAV.  

  • GI findings - Approximately 50% of children with IgAV have GI manifestations. These range from mild (nausea, vomiting; and cramping abdominal pain) to severe (severe abdominal pain, melena, bloody diarrhea, hematemesis, massive GI hemorrhage).

  • Joint findings - Arthritis/arthralgia occurs in 74% of patients and is the presenting feature in as many as 15% of pediatric cases. Joints may be swollen, tender, and painful; however, warmth, erythema, and effusions are not typical. The knees and ankles are most commonly affected. Young children with lower extremity involvement will refuse to walk. Rarely, the fingers and wrists may be involved. The arthritis is usually transient or migratory and oligoarticular (one to four joints involved). Joint involvement may precede the onset of purpura but usually not by more than one or two days. [3]  

  • Other findings - Vasculitis involving the myocardium or lungs; stenosing ureteritis, priapism, penile edema, or orchitis; vasculitis involving the central nervous system (CNS) and intracranial hemorrhage with confusion and convulsions; bilateral subperiosteal orbital hematomas; adrenal hematomas; acute pancreatitis as the sole presenting feature (rare) [4] ; cystic changes of the ovaries

See Presentation for more detail.


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