A Case of Henoch–Schönlein Purpura with Kawasaki Disease

Excerpt

To the Editor: A 5-y-old boy presented with edema and palpable purpuric lesions over both legs, fever, single cervical node on the right (1 × 1 cm) for 1 wk and was managed as Henoch–Schönlein Purpura (HSP). Investigations revealed leukocytosis and elevated acute phase reactants (Table 1). Urine routine showed pyuria and was sterile. Chest radiograph showed hilar infiltrates. Blood culture was sterile. During the course of hospital he continued to be febrile and his unilateral cervical adenitis and hepatosplenomegaly increased. Serial investigations with focus on acute phase reactants seemed to be on the rise (Table 1). Skin biopsy was consistent with vasculitis and HSP (Table 2). Echocardiography done due to clinical suspicion of Kawasaki disease (KD) revealed mild ectasia of left anterior descending (LAD) artery and left main coronary artery (LMCA). He was started on intravenous immunoglobulin (IVIG) 2 g/kg along with aspirin in anti-inflammatory dose, became afebrile within 48 h and discharged on aspirin, only to return 4 d later with inflammatory scrotal swelling and recurrence of palpable purpuric spots. A torsion testis was ruled out by doppler study. In view of findings of epididymoorchitis, child was started on steroids with which angioedema and scrotal swelling subsided. He is under follow-up and is doing well now. …