Fundamentals of differential diagnosis of hemorrhagic vasculitis

Abstract

It is quite rare, but in the practice of a family doctor, a condition may occur when, after an upper respiratory tract infection, flu or tonsillitis, the patient develops petechial rashes, hemorrhages in the mucous membranes, articular syndrome develops and abdominal pain appears. The first elements of the rash appear symmetrically first on the lower extremities, and then spread throughout the body. Joint lesions are characterized by severe pain syndrome and swelling; changes usually affect large joints – knee and ankle, but sometimes smaller articular surfaces are affected. Hemorrhages in the intestinal wall and mesentery are the cause of abdominal pain, flatulence, bowel disorders; nausea and vomiting are possible, sometimes mixed with blood. All these signs are characteristic of hemorrhagic vasculitis, which is also called Henoch–Schonlein purpura, capillary toxicosis or allergic purpura. For the first time, a description of several cases of purpura associated with arthritis was given by a German doctor Johann Schonlein in 1937, and a few decades later this nosology was described in detail by Eduard Henoch in his scientific work. In this pathological condition, autoimmune damage to small arteries is observed, as a result of which they become fragile, their permeability increases, resulting in the development of microthrombosis and multiple small hemorrhages in the skin, mucous membranes and internal organs. The disease most often occurs in children and adolescents, however, cases of diagnosis of hemorrhagic vasculitis have been described in adults as well [7].