Henoch–Schonlein Purpura in an Adult Presenting Atypically with Upper-Limb Cutaneous Involvement

Abstract

Background: Henoch Schonlein Purpura (HSP) is a systemic vasculitis which manifests as a triad of skin rashes, joint pain and abdominal pain. The cutaneous manifestations include nonthrombocytopenic, nonblanching palpable purpura. The skin lesions are usually seen mainly in the lower limbs and this has been ascribed to the effects of gravity. The disease is common in childhood and relatively rare in adulthood. Case Report: A 60 year old female presented with two weeks history of rashes, abdominal pain, loose stools, knee and shoulder pain. The rashes were multiple and symmetrical and first noticed by her in left upper limb, within a day appeared on the other limb and lower limbs also. Skin biopsy report revealed leukocytoclastic vasculitis with neutrophilic infiltration and prominent nuclear fragmentation, involving the upper and middle layers of the dermis with IgA deposition on immunofluorescence. She was treated with Oral Prednisolone 20 mg BID. The rash had resolved at follow up with resolution of symptoms. The unique feature of this case was involvement of upper limbs and age of the patient. Conclusion: This case underlines the points that occasionally even the upper limb can be involved and even elderly adults can have this condition. There is a need for clinicians to be aware of the varied presentations of this condition.