Henoch - Schonlein purpura syndrome

[Outlined]
Henoch - Schonlein purpura syndrome (Allergic Purpura Syndrome), also known as Schonlein-Henoch purpura, capillary poisoning hemorrhagic disease (Hemorrhagic Capillary Toxicosis) is the result of microvascular caused by the abnormal bleeding systemic disease, involving the skin, joints, there gastrointestinal and kidney corresponding symptoms. The disease was particularly prevalent in children and adolescents.
[Diagnosis]
According to the upper respiratory tract infection, a skin purpura, and joints, abdomen and kidney involvement at the same time the performance of a recurrent feature of this disease should consider the possibility. It should be noted, and thrombocytopenic purpura, acute abdomen, glomerulonephritis, rheumatoid arthritis were identified.
[Treatment]
1. Removal causes: including anti-infection, remove感染灶to remove intestinal parasites, avoid application of the food and drug allergies. 2. Antihistamine drugs: the choice of chlorpheniramine, promethazine, diphenhydramine, such as drug Astemizole oral or intramuscular injection. Also Applications 10% glucose intravenous calcium 10 ml per day 1-2 times.
3. Glucocorticoid: acute phase and applied to the abdomen, joint pain obviously, can quickly ease the symptoms. Oral prednisone may be given, if necessary, hydrocortisone infusion. Short-term treatment (3-5) can ease the symptoms of withdrawal, but use a longer time after the reductions should gradually stop.
4. Other: the acute phase should bed rest, gastrointestinal symptoms should fasting. High-dose intravenous vitamin C (3 to 5 g / day). Abdominal pain can be intense intramuscular injection of atropine 0.5 to 1 mg. There are bleeding tendency may choose to use drugs to stop bleeding. Have kidney damage.
【Etiology:
The disease of unknown, and may be related to various factors, ① infection, the disease often in acute infection, the incubation period and after a certain incidence, mostly acute upper respiratory infection, hemolytic streptococcus pathogens to mainly, but also for gold Staphylococcus aureus, viral, and parasitic infections, ② food allergy, such as fish, prawns, crabs, and other allograft milk protein allergy can be induced by the disease, ③ drugs, such as Green streptomycin, sulfonamides, salicylic acid such formulations. It was also possible with the cold, insect bites, such as pollen dust exposure factors. All these factors have on the human small arteries, veins and capillaries small wall of inflammatory changes, increased vascular permeability caused subcutaneous tissue, and organ mucosal vascular hemorrhage of exudative edema, and a corresponding clinical manifestations.
【Pathological changes:
Blood and skin around the infiltration of lymphocytes and plasma cells, dermal capillary layer was inflammatory changes, exudative, edema, hemorrhage, and cause skin purpura. Intestinal mucosal layer edema, exudative, and bleeding caused abdominal pain, and so is the reason. Joint pain and peripheral edema due mainly to joints, the joint cavity caused by leakage. Renal involvement Visibility glomerular cell proliferation, necrotic foci with capillary thrombosis, renal tubular epithelial cells also visible swelling, degeneration, fibrosis.
Clinical manifestations】 【
Onset before 1 ~ 3 weeks are often the history of upper respiratory infection, the slow onset, duration protracted, often attack with ease in turn, according to the lesion site of different violations, and have different clinical manifestations:
1. Skin performance: most of the skin purpura as the first symptom. Often seen in the distal limb extensor side of hip back, face and torso rare Purpura showed symmetric distribution, in batches, sizes, and integration into films, or even hemorrhagic herpes and haemorrhagic necrosis. Purpura general a few days to be dissipated. A few may be accompanied by eyelids, lips, the hand-foot-site vascular edema or urticaria.
2. Gastrointestinal change: multi purpura for skin after abdominal symptoms, but also in gastrointestinal symptoms as the first persons. Mainly for paroxysmal or continuing in or lower abdomen, accompanied by nausea and vomiting, weight, there hematochezia, hematemesis, intussusception and intestinal perforation. Investigations have tenderness in the abdomen, without the muscle tension and anti-. If abdominal symptoms as the main performance, known as abdominal anaphylactoid purpura (Henoch Purpura).
3. Joint performance: the performance of joint swelling limbs pain to the knee, ankle, elbow, wrist, and so common, and often migrans, a few days dissipated, can be repeated attack, attack often accompanied by low heat. A joint symptoms for outstanding performance, known as joint - anaphylactoid purpura (Schonlein Purpura).
4. Kidney performance: changes in the kidney followed often Purpura showed proteinuria, hematuria, and urinary tube type, and some patients can be accompanied by swelling, oliguria and hypertension. Under normal circumstances the kidney damage of the disease better resume, leaving sequels, a few may be turned into a chronic nephritis, or uremia. Should occasional attention to the main renal lesions were not obvious and Purpura performance.
Exudative other vascular hemorrhage and edema can also involving the nervous system, respiratory tract, and other emerging corresponding symptoms.
【Auxiliary inspection --
Bleeding time, the clotting time, platelet count and function normal, normal or mildly ESR can be increased fast. Some patients capillary fragility test (beam-arm test) positive. Renal involvement can have proteinuria, hematuria, possession of urine.