Rare and striking complication of Henoch-Schönlein purpura

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Rare and striking complication of Henoch-Schönlein purpura

MOUSSAOUI, Dehlia, BARASCHE, Judith, LACROIX, Laurence Elisabeth

MOUSSAOUI, Dehlia, BARASCHE, Judith, LACROIX, Laurence Elisabeth. Rare and striking complication of Henoch-Schönlein purpura. Archives of Disease in Childhood , 2018

DOI : 10.1136/archdischild-2018-316134 PMID : 30470683

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http://archive-ouverte.unige.ch/unige:128326

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1 Moussaoui D, et al. Arch Dis Child Month 2018 Vol 0 No 0

Rare and striking complication of Henoch-Schönlein purpura

A previously healthy 5-year-old boy presented to the emergency department with a non-traumatic painful oedema and purpuric rash of the penis, but no discomfort on micturition (figure 1).

Examination revealed petechial rash on both legs and swelling of the right hand. A week earlier, he had suffered from an acute obstructive bronchitis, treated with salbutamol but no steroids.

Urinalysis, full blood count, coagulation and kidney function tests were normal.

The diagnosis of Henoch-Schönlein purpura with penile involvement was established. Henoch-Schönlein purpura is the most common immune-mediated systemic vasculitis in children.

In the literature, a 13%–22% rate of scrotal oedema is reported in affected boys, sometimes as the only initial presentation of the disease.1 However, involvement of the glans, foreskin and penile shaft has rarely been reported. Penile manifestations of Henoch-Schönlein purpura include thrombosis, priapism and cutaneous purpuric lesions.2

No correlation exists between genitourinary involvement and renal complications. In patients with penile manifestations,

indications for steroids remain controversial. The literature provides only rare case reports relating empiric steroid treat- ments.3–5 No matter the treatment regimen applied, the local evolution always seemed favourable.

The patient received a 6-day course of prednisone 2 mg/kg/day because of concurrent abdominal pain. Abdominal symptoms resolved after 1 day and penile lesions 1 week later. Follow-up at 1 month showed no haematuria, no proteinuria and normal blood pressure.

Although rare, penile involvement in Henoch-Schönlein purpura must be recognised by physicians to avoid unnecessary investigations and concerns, with caution not to mistake this unusual presentation with non-accidental injury.

Dehlia Moussaoui, Judith Barasche, Laurence Lacroix

Department of Pediatrics, University Hospitals Geneva, Geneva, Switzerland Correspondence to Dr Dehlia Moussaoui, Department of Pediatrics, University Hospitals Geneva, Geneva 1211, Switzerland; dehlia. moussaoui@ hcuge. ch Contributors All authors have contributed equally to the manuscript.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Patient consent Parental/guardian consent obtained.

Provenance and peer review Not commissioned; externally peer reviewed.

© Author(s) (or their employer(s)) 2018. No commercial re-use. See rights and permissions. Published by BMJ.

To cite Moussaoui D, Barasche J, Lacroix L. Arch Dis Child Epub ahead of print:

[please include Day Month Year]. doi:10.1136/archdischild-2018-316134 Accepted 10 November 2018

Arch Dis Child 2018;0:1. doi:10.1136/archdischild-2018-316134 RefeRences

1 Søreide K. Surgical management of nonrenal genitourinary manifestations in children with Henoch-Schönlein purpura. J Pediatr Surg 2005;40:1243–7.

2 Dalpiaz A, Schwamb R, Miao Y, et al. Urological Manifestations of Henoch-Schonlein Purpura: A Review. Curr Urol 2015;8:66–73.

3 Tewary KK, Khodaghalian B, Narchi H. Acute penile pain and swelling in a 4-year-old child with Henoch-Schönlein purpura. BMJ Case Rep 2015;2015:bcr2013202341.

4 Pennesi M, Biasotto E, Saccari A. Schönlein-Henoch purpura involving the penis. Arch Dis Child 2006;91:603.

5 Ferrara P, Marrone G, Nicoletti A, et al. Penile involvement in Henoch-Schönlein purpura with good prognosis. Scand J Urol Nephrol 2007;41:567–9.

Images in paediatrics

Figure 1 Oedema and purpuric rash of the penis.

Geneve. Protected by copyright. on November 11, 2019 at Bibliotheque Faculte Medecinehttp://adc.bmj.com/Arch Dis Child: first published as 10.1136/archdischild-2018-316134 on 23 November 2018. Downloaded from

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