Henoch Schonlein Purpura (HSP) is the most common vasculitides that mainly happen in children with incident of 70 cases per 100000 children a year in Asia. The clinical manifestation of HSP is purpura or petechiae, abdominal pain, joint pain, and renal involvement. Here is reported a case about the underdiagnosis in a HSP patient presented with abdominal pain and vomiting with blood spot and late appearance of purpura.
A 12-year-old girl visited children clinic in RSUD Bajawa with the chief complaints of red rash and pain in her lower limbs. Five weeks before, she came to the hospital with the symptom of abdominal pain and vomiting with blood spots, but the abdominal ultrasonography, blood, and urinalysis results came out normal. She was admitted for abdominal pain observation and was discharged after five days of care.
On physical examination, the vital signs were within normal limit. There were erythematous, nonpruritic, palpable purpura with diameter of 1-5 mm in the lower extremities up to the buttock. In the fourth day of care, the purpura progressed from to the both arms and face despite not as many as at the lower limbs. There was pain at the lower limbs which was exaggerated by movement. Other examinations were within normal limit. The laboratory tests showed normal blood and urinalysis results.
Patient then diagnosed with HSP and treated with intravenous (IV) fluid resuscitation, IV ranitidine, and oral ibuprofen. After twelve days, the pain in the limbs and the purpura was alleviated and the patient was discharged.
Palpable purpura is seen as the presenting sign in most of HSP cases. Meanwhile in this case, abdominal pain preceding skin manifestation by five weeks. Thus, in children with gastrointestinal complaint, HSP may be considered.