S C O T T G U R U S I N G H E

(HEN-AWK SHURN-LINE PUR-PU-RUH)

Henoch Schonlein Purpura (HSP)

HSP Case Study

Previously had tonsillitis (4 weeks prior)

Generally feeling unwell

Spots (pin head) around ankle and lower leg

GP

Went shopping

Emergency Department

16yr old

Within the hour

Spreading purpuric rash

Severe joint pain

Associated epileptiform movements

Biochemistry lab results

14/03/2018 15/03/2018 16/03/2018 Units

Chemistry

Sodium 140 mmol/L

Potassium 4.3 mmol/L

Chloride 97 mmol/L

Bicarbonate 23 mmol/L

Creatinine 68 umol/L

Urea 5.9 mmol/L

CRP 7 mg/L

Randon Glucose 9.9 mmol/L

Lactate 1.9 mmol/L

CK 152 U/L

AST 17 U/L

ALT 14 U/L

Bilirubin 4 umol/L

ALP 114 U/L

GGT 20 U/L

TOTAL Protein 82 g/L

Albumin 45 g/L

Urine Chemistry

Urine Creatinine 4.7 mmol/L

Urine Protein 0.05 g/L

Prot/Creat Ratio 11 mg/mmol creat

Haematology lab results

14/03/2018 Units Reference Range

CBC

HB 142 g/L (110-160)

RBC 5.2 10^12/L (3.8-5.4)

HcT 0.42 L/L (0.36-0.46)

MCV 81 fL (50-300)

MCH 27 pg (27-34)

PLATE 349 10^9g/L (144-440)

TOTAL WBC 14.7 10^9g/L (4.0-11.0)

NEUTROPHIL 10.1 10^9g/L (2.0-7.5)

LYMPHOCYTE 3.5 10^9g/L (1.5-4.0)

MONO 1 10^9g/L (0.2-7.5)

EOSIN 0.1 10^9g/L (0.0-0.5)

BASO 0 10^9g/L (0.0-0.3)

IMM GRAN 0 10^9g/L

INR 1.1 ratio (0.9-1.1)

APTT 26 sec (23-35)

Immunology lab results

16/03/2018 Units Reference Range

Immunology

ANCA Negative

Amino Acids Normal

Immunoglobulin G 11.6 g/L (5.4-15.5)

CSF Oligo IgG Band Negative

IgG Cardiolipin 3.5 (<15)

IgM Cardiolipin 2.3 (<12)

ANA Titre <80 (<80)

Microbiology lab results

15/03/2018 16/03/2018 Units Reference Range Comment

Micro - CSF

WBC 3 /ul Gram stain: No Organism seen

RBC 1 H /ul Culture: No growth

CSF Protein 0.24 g/L (0.15-0.40)

CSF Glucose 6.9 H mmol/L (2.8-4.4)

Urine Culture

Lymphocytes <10 x10^6/L (<10x10^6/L) Culture: no growth

Red cells <10 x10^6/L (<10x10^6/L)

Epithelial cells <10 x10^6/L (<10x10^6/L)

Bacterial inhibitor not detected

Blood Cultures

Anarobic PositiveGram Stain: Gram pos Bacilli

seen

Aerobic Negative No growth after 5 days

Treatment

Meningococcus antibiotics

Methotrexate

Prednisone

HSP

Inflammation of small blood vessels

Children

Certain organs vessels start leaking

Rash

Race

Time of year

More common in boys than girls

Ends after four to six weeks

No long term consequence

Kidneys and Intestines

Cause and Risk Factors

Unknown

Immune System

Two thirds of cases

SYMPTOMS

Rash

Joint pain

Abdominal pain

Kidney impairment

Skin Biopsy

Normal Skin Biopsy HSP Skin Biopsy

Joint Inflammation

Intussusception (In-tus-sus-cep-tion)

Colonoscopy of HSP affected bowel

Kidneys

Treatment

Treatment still remains controversial

Corticosteroids – use or not use

Prednisone

Treatment indicated on appearance of biopsy sample

Prognosis

Good prognosis for most patients

Reoccurrence of condition

HSP: Halal Snack Packs