Abstract
BackgroundHenoch-Schönlein purpura (HSP) is the most common vasculitis of childhood. It has a characteristic rash described as palpable purpura that most frequently affects the distal lower extremities and buttocks. HSP rarely presents with bullous rash nor pulmonary nodules.Case presentationWe present a novel case of a 12-years-old female with recurrent pediatric HSP with a combination of the rare manifestations of bullous rash and pulmonary nodules. She initially presented with the bullous rash, chest pain, cough, and abdominal pain. Patient was successfully treated with intravenous pulse corticosteroids followed by a high dose oral corticosteroid taper, with resolution of the bullous rash and pulmonary nodules.ConclusionThe rare manifestations of scarring bullous rash and pulmonary nodules can be presenting features of pediatric HSP, the combination of which has not been previously reported. The treatment of intravenous corticosteroid resolved patient’s abdominal symptoms, rash and pulmonary nodules.
Highlights
ConclusionThe rare manifestations of scarring bullous rash and pulmonary nodules can be presenting features of pediatric Henoch-Schönlein purpura (HSP), the combination of which has not been previously reported
Henoch-Schönlein purpura (HSP) is the most common vasculitis of childhood
The prevalence of HSP with pulmonary involvement is approximately 0.8 to 5% [6]. The combination of both bullous rash and pulmonary nodules in a single patient diagnosed with HSP has not been reported in the literature
Summary
Both scarring bullous rash and pulmonary nodules are rare manifestations of pediatric HSP; we have not encountered this combination of HSP symptoms in the published literature. Our patient received clear clinical benefit from corticosteroid therapy in resolving her abdominal symptoms, rash, and pulmonary nodules; these results align with conclusions made by Weiss et al in their 2007 meta-analysis [11]. Their statistical analysis suggested but failed to identify a significant corticosteroid dose-response effect [11]. Our case supports the use of intravenous pulse corticosteroids for the management of recurrent pediatric HSP with atypical presentations of bullous rash and pulmonary nodules
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