Recently, children with red rashes on both lower legs have been visiting the clinic from time to time. Most rashes are petechial manifestations, painless and itchless, and the rash persists and does not fade after pressing.
In combination with the child’s history of upper respiratory tract infection before the rash appeared, it is easy to diagnose “IgA vasculitis”(IgA vasculitis, IgAV), a name more familiar to everyone is “Henoch-Schönlein purpura”.
Many parents become nervous upon hearing the term “Henoch-Schönlein purpura”: “Doctor, is my child allergic to something that causes skin bleeding? Do they need to avoid certain foods or get allergy tests?”
Actually, Henoch-Schönlein purpura is an old term for the disease, now more clinicians would refer to this disease as “IgA vasculitis”. This is a relatively common systemic vasculitis in children, with an incidence rate of (3-27)/100,000.
What is IgA vasculitis?
IgA vasculitis is common in adolescents and children, usually caused by infections, which is not the same as the “food allergies” or “pollen allergies” we often talk about.
Literature indicates that about half of IgA vasculitis followsupper respiratory tract infections, especially those caused by Streptococcus infections. In addition, vaccinations and insect bites can also trigger it, but they are relatively rare.
Unlike the purpuric diseases of the blood system that many people worry about, it is usually a self-limited vasculitis episode, if early recognition can be achieved and close observation is maintained, most cases will gradually improve on their own. Moreover, allergy tests are usually not required.
What are the common manifestations of IgA vasculitis?
💡Key points:
It is important to note that some patients may first experience recurrent abdominal pain, hematochezzia, or arthralgia, and then purpura on both legs appears a few days later. In this case, without seeing the purpuric rash, IgA vasculitis may not be considered by doctors at first, so sometimes it may be misdiagnosed as “acute gastroenteritis” or even “acute appendicitis”.
1. What does the purpuric rash look like?
At the beginning, the rash usually manifests as symmetrical red spots the size of sesame to rice grains, some may appear as raised dark red maculopapular rashes, a few combined with urticarial wheals or target-like erythema.
If the child continues to exercise frequently after the rash is found (including walking), a large number of new petechial rashes or confluent ecchymotic rashes may appear on the second or third day. Usually, the lower limbs or buttocks are mainly affected, and then gradually involve the abdomen, upper limbs, or other areas of the trunk.
In addition to petechiae, some children may have local subcutaneous edema, commonly seen in the orbital area of children under 3 years old or areas of the body where gravitational pressure while sleeping.
2. What does the accompanying arthralgia/arthritis feel like?
Usually IgA vasculitis -associated joint pain is transient or migratory pain (pain appears in different parts of the body), commonly seen in knees, ankles, or hips, and may occur in the early or middle stage of the disease.
However, there is generally no joint effusion, redness, or increased skin temperature. Some patients may have significant pain and limited mobility, but after adequate rest or medication, joint symptoms can disappear without causing chronic damage or sequelae.
3. What are the accompanying gastrointestinal symptoms like?
About 25%-50% of children may experience gastrointestinal symptoms:
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Mild cases: Nausea, vomiting, abdominal pain, and short-term pseudo-obstruction of the intestine;
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Severe cases: Gastrointestinal bleeding, intestinal ischemia and necrosis, intussusception, and intestinal perforation.
Some gastrointestinal bleeding symptoms may persist for several weeks.
4. What are the accompanying renal symptoms like?
Usually no obvious gross hematuria, often requiring laboratory urinalysis to confirm early renal changes.
What should parents do if they see purpura on their child’s lower legs?
See a doctor immediately, complete blood routine examination, coagulation tests, to rule out other systemic purpuric diseases of the blood system, or bleeding diseases caused by deficiencies such as prothrombin.
If there are symptoms such as abdominal pain, joint pain, it is recommended to check for fecal occult blood, urinalysis, etc., to rule out the risks of gastrointestinal bleeding, hematuria, proteinuria, etc., caused by kidney damage.
If urinalysis is abnormal, with proteinuria or hematuria, it is recommended to see a nephrologist.
How should IgA vasculitis be treated?
The vast majority of IgA vasculitis patients can recover on their own, and doctors may give the following advice:
However, for severe intractable abdominal pain or joint pain, and oral painkillers are ineffective, systemic corticosteroids are usually recommended, and hospitalization is usually advised.
For children with abdominal pain who cannot take oral rehydration, hospitalization for intravenous rehydration is also recommended.
Will it recur throughout life?
Actually, according to current literature reports, most children recover quite well. More than half (about 2/3)of the children will not relapse.
The remaining children (about 1/3) may relapse once, usually within the first half year after the initial illness. If relapse occurs, the symptoms are generally milder or shorter in duration than the first time.
If this illness was caused by a cold or fever, the possibility of relapse is relatively small. If this time there was arthralgia or abdominal pain, the possibility of relapse next time will be greater.
The most important thing to pay attention to here is the children with kidney involvement, if the kidney is affected, the vast majority(90%) will be discovered within the first two months of illness. Almost all (97%) of the children with kidney damage will be discovered within half a year, adults with this disease are more likely to have kidney problems, both at the onset of the disease and later.
💡So, a particularly important point:
Understanding these situations, if you encounter suspicious rashes, always seek medical help in time!
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