A child presents with gross hematuria, abdominal pain, arthralgia, and a purpuric rash. Which diagnosis is most likely?

A child presents with gross hematuria, abdominal pain, arthralgia, and a purpuric rash. Which diagnosis is most likely?

• A. Rhabdomyosarcoma
• B. Systemic lupus erythematosus
• C. Sickle cell disease
• D. Henoch-Schönlein purpura

Answer: (D)

This presentation is classic for Henoch-Schönlein purpura, now known as IgA vasculitis. The combination of palpable purpura with abdominal pain, arthralgia, and kidney involvement (gross hematuria) reflects a small-vessel vasculitis with IgA immune complex deposition that affects the skin, gut, joints, and kidneys. The purpura is typically palpable and located on the buttocks and legs, arising from leukocytoclastic vasculitis rather than a platelet problem. Abdominal pain comes from vasculitis of the gastrointestinal tract and can be colicky, sometimes with GI complications; arthritis is common in large joints. Renal involvement can range from mild hematuria to more significant proteinuria, echoing IgA nephropathy in the kidneys. This condition often follows a recent upper respiratory infection and is usually self-limited, with most cases resolving in weeks, though renal monitoring is important because some children can have ongoing kidney involvement. Treatments focus on supportive care, with attention to hydration and pain control; steroids may be used for severe abdominal pain or renal involvement if needed.

This presentation is classic for Henoch-Schönlein purpura, now known as IgA vasculitis. The combination of palpable purpura with abdominal pain, arthralgia, and kidney involvement (gross hematuria) reflects a small-vessel vasculitis with IgA immune complex deposition that affects the skin, gut, joints, and kidneys. The purpura is typically palpable and located on the buttocks and legs, arising from leukocytoclastic vasculitis rather than a platelet problem. Abdominal pain comes from vasculitis of the gastrointestinal tract and can be colicky, sometimes with GI complications; arthritis is common in large joints. Renal involvement can range from mild hematuria to more significant proteinuria, echoing IgA nephropathy in the kidneys. This condition often follows a recent upper respiratory infection and is usually self-limited, with most cases resolving in weeks, though renal monitoring is important because some children can have ongoing kidney involvement. Treatments focus on supportive care, with attention to hydration and pain control; steroids may be used for severe abdominal pain or renal involvement if needed.