Abstract Ref Number = APCP734
THROMBOSIS EVENT IN 5-YEAR-OLD HENOCH-SCHONLEIN PURPURA PATIENT
Diah Nur Savitri Ashary,Mirari Prasada Judio
Hermina Kemayoran Hospital
Background : Henoch – Schonlein purpura (HSP) is the most common type of small vessel vasculitis in children. Boys are mostly affected than girls, with peak incidence 4-6 years of age. Diagnosis is commonly made by clinical findings, which include palpable purpura and one of the following: diffuse abdominal pain, predominant IgA deposition (skin biopsy), acute arthritis and kidney abnormalities (hematuria, and or proteinuria). Frequent complications of HSP are gastrointestinal bleeding and intussusception. However, we present a case of 5-year-old boy diagnosed with Henoch-Schonlein purpura with thrombosis as an untypical complication.
Case Presentation Summary : A 5-year-old boy was brought to Emergency Department with pain, edema in the lower extremities, and difficulty to walk. Previous history revealed diarrhea and mumps few days prior to. On physical examination we found high blood pressure (140/90mmHg), tachycardia (154bpm), but normal temperature and respiration rate. Wong-Baker FACES pain score was 4-6. There was no pain during abdominal palpation. Palpable purpura and non-pitting edema from knee below were felt on both legs. They looked pale with delayed capillary filling (>3seconds). Blood count showed leukocytosis (17.600/µL), thrombocytosis (531.000/ µL) and increase D – Dimer (1.9µL/ml). Urinalysis was normal. Patient was then treated by heparin 500IU/kg, intravenous antibiotic, and oral methylprednisolone. Peripheral vascularization was better after 15 hours of heparinization. On 5th day of care, patient was discharged with no significant morbidity and sequelae. He continued receiving oral steroid until it was tapered off.
Learning Points/Discussion : Thrombosis is rare complication of HSP and potentially life-threatening condition. Prompt heparinization is critical in the situation, as well as good clinical judgment in reducing morbidity.
Keywords: Thrombosis Henoch-Schonlein purpura Complication