Lumbar Swelling as the Unusual Presentation of Henoch-Schonlein Purpura in a Child

Abstract

Background: Henoch-Schönlein Purpura (HSP) is a systemic hypersensitivity disease of unknown cause that is characterized by a purpuric rash and systemic manifestations, such as colicky abdominal pain, polyarthralgia, and acute glomerulonephritis. Common complications of HSP that lead to surgical intervention include intussusception, perforation, necrosis, and massive gastrointestinal bleeding. Unusual clinical manifestations of HSP may include edema of the scrotum and eyes. Lumbar swelling is rarely seen as a complication of HSP. Case Report: A four-year-old boy was admitted to our emergency room with a 7 day history of increasing abdominal pain. Within 48 hours of admission, erythematous macules and palpable purpuric lesions developed on the lower extremities. On the third day of hospitalization, sudden onset of severe back pain, swelling on the lumbar region and refusal to walk were seen. On the fifth day, lumbosacral edema and pain resolved but facial edema developed. He was diagnosed clinically with HSP. Conclusion: To the best of our knowledge, only a few cases of HSP with lumbar edema have been reported so far. If the first clinical symptoms of HSP are atypical, clinical progress can be atypical, too.

Painful subcutaneous edema of the lumbar region in IgA vasculitis

“…Subcutaneous edema of the lumbar area, however, is a very rare presentation of IgA vasculitis. Although subcutaneous edema of the extremities due to IgA vasculitis is not usually accompanied by severe pain, in the present case, as well as in previously reported cases, the patients complained of severe pain in the affected edematous area. Severe pain as seen in the present case may be associated with rapid progression of edema of the subcutaneous tissue along the fascia.…”

Low Back Pain and Swelling as an Atypical Presentation of IgA Vasculitis

“…This patient had hemoccult-positive stool and only later developed the lumbar swelling on day 3 of hospitalization. 4 The lumbar swelling resolved after two days; however, that patient did develop facial edema that required ongoing corticosteroid treatment. 4 In the second case, the patient's presenting symptom was back pain and refusal to ambulate after a febrile illness and development of a rash.…”

“…4 The lumbar swelling resolved after two days; however, that patient did develop facial edema that required ongoing corticosteroid treatment. 4 In the second case, the patient's presenting symptom was back pain and refusal to ambulate after a febrile illness and development of a rash. Magnetic resonance imaging was performed, which demonstrated edema of the lumbosacral fascial planes.…”

“…1,2 After a literature review, we identified only two previous cases of IgA vasculitis associated with lumbar pain and swelling in a child diagnosed with IgA vasculitis. 4,5 In one of these cases, the patient's presenting symptoms were abdominal pain rather than back pain. This patient had hemoccult-positive stool and only later developed the lumbar swelling on day 3 of hospitalization.…”

The role of T cells in the development of Henoch-Schonlein purpura

“…Joint pain sometimes precedes the classical rash by one or two weeks. These symptoms subside when the disease clears and leave no lasting damage (31). The third characteristic is gastrointestinal symptoms which many children with HSP develop, including abdominal pain, nausea, vomiting or bloody stools.…”