BACKGROUND & AIMS:
:Henoch-Schönlein purpura (HSP) is generally a self-limited vasculitis disease and has a good prognosis. We report a 4-year-old Thai boy who presented with palpable purpura, abdominal colicky pain, seizure, and eventually developed intestinal ischemia and perforation despite adequate treatment, including corticosteroid and intravenous immunoglobulin therapy. Imaging modalities, including ultrasonography and contrast-enhanced computed tomography, could not detect intestinal ischemia prior to perforation. In this patient, we also postulated that vasculitis-induced mucosal ischemia was a cause of the ulcer, leading to intestinal perforation, and high-dose corticosteroid could have been a contributing factor since the histopathology revealed depletion of lymphoid follicles. Intestinal perforation in HSP is rare, but life-threatening. Close monitoring and thorough clinical evaluation are essential to detect bowel ischemia before perforation, particularly in HSP patients who have hematochezia, persistent localized abdominal tenderness and guarding. In highly suspicious cases, exploratory laparotomy may be needed for the definite diagnosis and prevention of further complications.
背景与目标:
: 过敏性紫癜 (HSP) 通常是一种自限性血管炎疾病,预后良好。我们报告了一名4岁的泰国男孩,尽管接受了适当的治疗 (包括皮质类固醇和静脉内免疫球蛋白治疗),但仍出现明显的紫癜,腹部绞痛,癫痫发作,并最终发展为肠缺血和穿孔。成像方式,包括超声检查和对比增强计算机断层扫描,无法在穿孔前检测到肠缺血。在该患者中,我们还推测血管炎诱导的粘膜缺血是溃疡的原因,导致肠穿孔,并且由于组织病理学显示淋巴滤泡耗竭,大剂量皮质类固醇可能是促成因素。HSP的肠穿孔很少见,但会危及生命。密切监测和全面的临床评估对于穿孔前发现肠缺血至关重要,尤其是在患有便血,持续性局部腹部压痛和监护的HSP患者中。在高度可疑的情况下,可能需要进行探查性剖腹手术以明确诊断并预防进一步的并发症。