Management of Henoch-Schonlein Purpura Treated with Oral Steroids

A 38-year-old man with irritable bowel syndrome (IBS) went to the clinic with significant central abdominal pain and a severe rash. The patient went to the Emergency Department (ED) the day before coming to the clinic for the same issues. The abdomen pain was colicky, according to the patient. There were no other symptoms such as nausea, vomiting, or GI bleeding, but he had an upper respiratory tract infection three weeks prior, after which he began to experience these symptoms. His ailment was treated with medication and cleared up quickly. The ED personnel had looked into the cause, including a CT abdomen with contrast, but all of the findings came back clear. At the time, his serum creatinine level was somewhat elevated. On clinical examination, the patient had severe tenderness in his abdominal region. The rash was extensive, reddish, raised, and purpuric in nature and had spread all over his lower limbs and hips on both sides. The upper limbs were also involved up to the forearms.

All the lab investigations conducted on the patient were normal, including CBC, Creatinine, Serum C3, C4, and the rheumatoid factor. CRP was found to be elevated and positive occult blood was seen in the stool of the patient.

The patient was diagnosed with abdominal angina based on a combination of the foregoing medical symptoms and testing. The symptoms followed a standard pattern: occult blood in the stool, purpuric rash, stomach pain, and renal involvement, all of which were preceded by a proven upper respiratory tract infection (URTI). The patient was later discovered to have all of the symptoms of immune-mediated IgA vasculitis (Henoch-Schonlein Purpura) and was treated accordingly.

The following sections of this case study will explore how the patient was diagnosed, treated, and managed accordingly to save his life. By doing so, this case will serve as an important study material for all concerned physicians and doctors to know what to do in case they encounter such a patient in their own clinical setting. The case explores in detail all the aspects that led to the final diagnosis of the patient, thus clarifying how doubts should be dealt with while encountering such confusing cases.