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Henoch-Schonlein Purpura

Hen and Shaolin-monk with Purple-cat
Picmonic
Henoch-Schonlein purpura (HSP) is a systemic vasculitis characterized by deposition of IgA immune complexes in skin and other organs. This is the most common childhood vasculitis and typically presents after pharyngeal and upper respiratory infections. The skin, joints, and GI are the most commonly involved organs. In the skin, immune complex deposition causes palpable purpura , which are small red or purple discolorations of the skin and is seen in all cases of HSP. Arthralgia and abdominal pain are also typically seen. Involvement of the GI tract can cause gastrointestinal hemorrhage which cause black stools. Forty percent of patients also have evidence of renal involvement with hematuria. The pathophysiology of HSP is similar to IgA nephropathy including high serum levels of IgA and similar findings on renal biopsy. However, IgA nephropathy typically only involves the kidneys and has a predilection for young adults while HSP is a systemic disease and involves other organs. Overall, the prognosis is good in most patients with high rates of recovery. In children under ten years of age, the condition recurs in about one third of the cases. 
7 KEY FACTS
Most Common Childhood Vasculitis
Child with #1 Foam-finger showing Vessels-on-fire

This vasculitis most commonly affects children and is the most common vasculitis seen in this population.

Follows Pharyngeal or Respiratory Infection
Pharaoh with Lungs

HSP usually follows pharyngeal and upper respiratory tract infectons.

Palpable Purpura on Legs and Buttocks
Palpable-paw-print from Purple-cat near Leg and Buttocks

Lesions that appear as red or purple discolorations on the skin that do not blanch on applying pressure. Recruitment and activation of neutrophils within the vascular bed of skin causes a palpable cutaneous purpura, which is commonly only seen in small vessel vasculitis and commonly presents on the buttocks and legs but can also be seen on the face, arms, and trunk. Palpable purpura is always seen in HSP.

Arthralgia
King Arthur-algae

Arthralgia means joint pain that is caused by a non-inflammatory condition. Arthralgia is seen in HSP due to involvement of the joints.

Intestinal Hemorrhage
Intestinal Hemorrhage-hammer

Abdominal pain is a common symptom of HSP due to involvement of the vessels of the GI tract. Involvement of the GI tract can also cause intestinal hemorrhage and can present with black tarry stools.

Black Stool (Melena)
Black Intestine-stool

Black tarry stool is a sign of intestinal hemorrhage, usually in the upper part of the gastrointestinal tract.

Associated with IgA Nephropathy
(IgA) Apple-goblin with Kidney

The pathophysiology of HSP is similar to IgA nephropathy including high serum levels of IgA and similar findings on renal biopsy. However, IgA nephropathy typically only involves the kidneys and has a predilection for young adults while HSP is a systemic disease and involves other organs.

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