Typical Purpura Research Articles

The characteristics of video capsule endoscopy in pediatric Henoch\u2013Sch\xf6nlein purpura with gastrointestinal symptoms

BackgroundHenoch–Schönlein purpura (HSP) is a systemic small-vessel vasculitis also named IgA vasculitis that commonly affects the gastrointestinal tract. The video capsule endoscopy (VCE) characteristics of pediatric HSP patients are rarely reported.MethodsPatients diagnosed with HSP and analyzed by VCE examination at our hospital from February 2010 to January 2020 are enrolled. The clinical features, laboratory findings, and the characteristics of VCE findings are studied.ResultsThere are 30 patients enrolled in this investigation from February 2010 to January 2020. The mean age of these patients is 96.9 ± 35.8 months, and the most frequent finding of VCE is mucosal erosion, which account for 79.3% of the patients, and followed by mucosal erythema or petechia accounted for 69% of the patients. Regarding the disease location detected by endoscopy, jejunum is the most common involved part of the gastrointestinal tract in pediatric HSP patients. All the patients had the jejunum involved except in one patient the VCE did not pass through the pylorus. One third of the patients involved the descending portion of duodenum. No side effect is observed in this study.ConclusionsVCE may be an excellent adjust tool for evaluation of the gastrointestinal tract in children with abdominal symptoms without typical purpura in suspected pediatric HSP patients. VCE appears to be superior to esophagogastroduodenoscopy in detecting small intestinal lesions of HSP and has an excellent safety profile.

Atypical purpura location in a pediatric patient with Henoch-Schönlein purpura

Rationale:The presence of purpura is a compulsory criteria for the diagnosis of Henoch-Schönlein purpura (HSP). Typical purpura of HSP is distributed symmetrically over the extensor surfaces of the lower limbs, buttocks, and forearms with the occasional involvement of trunk and face in children. It occurs only involving the bottom of the feet has never been reported.Patient concerns:A 7-year-old girl was admitted to the hospital with abdominal pain, vomiting, and fever.Diagnoses:Combining clinical manifestations with results of radiologic examinations, acute appendicitis was suspected and a laparotomy was considered. Purpura was found on the bottom of her feet when she was in the operating room and HSP was diagnosed.Interventions:The patient was treated with glucocorticosteroids, antibiotics, cimetidine, and restriction of feeding.Outcomes:The abdominal pain and purpura resolved at discharge and there were no recurrences in the subsequent 3-, 6-, and 12-month follow-ups.Lessons:Careful examination of skin including the bottom of the feet can help to direct the diagnostic workup for children with abdominal pain.

THE CONTRIBUTION OF GENES POLYMORPHISM OF THROMBOPHILIA IN CLINICAL VARIABILITY OF HEMORRHAGIC VASCULITIS

Background: The article is devoted to the study of clinical and laboratory characteristics of the current of hemorrhagic vasculitis in children in the Republic of Buryatia. Patients and methods: The study included 27 patients aged 7,6±4,02 years, who conducted clinical and laboratory tests, immunological study of antiphospholipids of antibodies, genetic testing for thrombophilia markers of candidate genes. Results: The results showed that hemorrhagic vasculitis often affects children of Buryat nationality. In 96% of cases there are mixed clinical forms of the disease. 63% of children of hemorrhagic vasculitis preceded by various factors, a higher percentage of infectious diseases. The first clinical symptom in 63% of patients is a typical purpura hemorrhagic rash. Results of clinical laboratory blood tests revealed no significant deviations. Circulation of lupus anticoagulant was detected in 37% of subjects . The аCL IgM detected in 3 children, aβ2-GP-I IgA — in 4 , aβ2-GP-I IgM — in 1 patient. Carriers of thrombophilia polymorphisms were in 95% of children. Noted that homozygous variants of genes polymorphisms of methylenetetrahydrofolateredreductase and plasminogen activator inhibitor-1 correlate with the presence of urinary symptoms and recurrence of the rash. Conclusion: The study shows the risk of recurrent flow of hemorrhagic vasculitis and nefritis of Henoch–Schonlein in children with thrombophilia gene polymorphism.

The contribution of genes polymorphism of thrombophilia in clinical variability of hemorrhagic vasculitis

The article is devoted to the study of clinical and laboratory characteristics of the current of hemorrhagic vasculitis in children in the Republic of Buryatia. The study included 27 patients aged 7.6 +/- 4.02 years, who conducted clinical and laboratory tests, immunological study of antiphospholipids of antibodies, genetic testing for thrombophilia markers of candidate genes. The results showed that hemorrhagic vasculitis often affects children of Buryat nationality. In 96% of cases there are mixed clinical forms of the disease. 63% of children of hemorrhagic vasculitis preceded by various factors, a higher percentage of infectious diseases. The first clinical symptom in 63% of patients is a typical purpura hemorrhagic rash. Results of clinical laboratory blood tests revealed no significant deviations. Circulation of lupus anticoagulant was detected in 37% of subjects. The alphaCL IgM detected in 3 children, alphabeta2-GP-I IgA--in 4, alphabeta2-GP-I IgM--in 1 patient. Carriers of thrombophilia polymorphisms were in 95% of children. Noted that homozygous variants of genes polymorphisms of methylenetetrahydrofolatered reductase and plasminogen activator inhibitor-1 correlate with the presence of urinary symptoms and recurrence of the rash. The study shows the risk of recurrent flow of hemorrhagic vasculitis and nefritis of Henoch-Schonlein in children with thrombophilia gene polymorphism.

Clinical diagnosis and treatment of 60 children with henoch-schonlein purpura

Objective To analyze the clinical data of henoch-schonlein purpura(HSP)in children and to conclude the clinieal featrues of HSP.Methods The clinieal features of 60 children with HSP were analyzed.Results(1)The age of onset of all the 60 children with HSP was from 3 to 14 yearn old,especially from 5 to 10 years and the female patients were more than the male patients(the ratewas 2:1).Of the 60 children,they developed HSP in the four seasons,especially in the spring and winter;most of the HSP patients revealed evident predisposing factors,mainly upper respiratory infection.(2)All the patients had typical purpura.80% had typical purpura as the presenting contancous sign.The distribution of rash in the lower extremitiees,buttock upper extremities and face was 100%,30%,13% and 7%.30% occurre,repeatedly.(3)Gastrointestinal involvement and arthritis occurred rate is 47% and 60%,respectively.Of all the patients,13% devdoped HSP nephritis manifested as isolated hematuria and/or protcinuria.Conclusion HSP has its own clinical and episodic features.It is not difficult to diagnose the typical case.HSPN is its serious syndrome,it should be long-term foflow-up of kidney conditions. Key words: Purpura; anaphylactoid; Child

PURPURA HAEMORRHAGICA FOLLOWING NEOARSPHENAMINE AND BISMARSEN THERAPY

In 1936 studies on 3 patients with purpura haemorrhagica following neoarsphenamine therapy were reported. 1 We ascertained by experiments that 2 of these patients were very sensitive to neoarsphenamine but apparently not sensitive to mapharsen, as the intravenous injection of this arsphenamine derivative failed to produce any significant effects on the platelets and capillaries or any untoward constitutional reaction. The third patient of the series disappeared from observation after leaving the hospital; hence no experimental studies were made. Since publication of the report mentioned, we have had an opportunity to study 6 additional patients who showed hemorrhagic phenomena following the therapeutic use of arsphenamine derivatives. It appeared to us important to record our experimental studies on these patients, particularly those on 5 patients of the series who showed typical purpura haemorrhagica following the use of neoarsphenamine or of bismarsen but who had no apparent reaction following the intravenous injection of

A consideration of the reduction of blood platelets in purpura

As is well known, typical purpura is characterized by a marked diminution in the number of platelets; whereas the normal individual has about 300,000 platelets per cubic centimeter of blood, the purpuric individual has less than 100,000. Evidently this abnormal condition may be due either to a lack of formation of these cells, or to their increased destruction. A number of studies have been undertaken to decide this question, but no conclusive evidence has been brought forward. The coagulation time of the plasma centrifugalized for fifteen minutes is normal in purpura or but slightly prolonged. If we centrifugalize plasma for two hours we find that, whereas the coagulation time in the normal case has been greatly prolonged—for example—from 8 to 18 minutes (Case 1, Table I), in the case of purpura, the centrifugation has frequently occasioned but little or no delay in coagulation (see Table I). This distinction may be interpreted as due to the fact that in the normal plasma we have removed all the platelet cells, whereas in the purpuric plasma, there is considerable platelet substance in solution which could not be removed by means of centrifugation. This question can also be answered by means of employing a dilute solution of hirudin, an antithrombic substance, which combines with thromboplastic substances such as platelets. If we remove practically all the suspended platelet cells by means of prolonged centrifugation, we shall then be able to determine whether or not there is platelet substance in solution by attempting to neutralize it by the addition of hirudin. This test has been carried out in many normal as well as purpura cases. It has been found that whereas the addition of the hirudin solution to the centrifugalized normal plasma brings about considerable delay (in Case 3 of the table, from 8 to 30 minutes), in the purpuric plasma on the contrary, a considerably less degree of retardation is effected (for example, in Case 7-from 11 to 16 minutes).