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Perforated appendicitis in a child with Henoch-Schönlein purpura

Bryce A Binstadt1, Eric W Fleegler

  • 1Rheumatology Program, Division of Immunology, Children's Hospital Boston, Boston, MA 02115, USA. bryce.binstadt@childrens.harvard.edu

Journal of Pediatric Surgery
|March 8, 2005
PubMed

Insights

Henoch-Schönlein purpura (HSP) can present with abdominal pain, mimicking surgical emergencies. This case highlights appendicitis occurring with an established HSP rash, emphasizing the need for careful diagnosis.

Area of Science:

  • Pediatric Rheumatology
  • Pediatric Surgery

Background:

  • Henoch-Schönlein purpura (HSP) is a common childhood vasculitis.
  • Abdominal pain is a frequent symptom, often prompting evaluation for intussusception.
  • Appendicitis is a rare complication, typically preceding rash onset in prior reports.

Observation:

  • This report details the first case of appendicitis developing in a child with an established HSP rash.
  • The patient presented with symptoms suggestive of appendicitis alongside the characteristic purpuric rash.
  • This case also represents the first documented instance of perforated appendicitis in the context of HSP.

Findings:

  • Appendicitis can occur concurrently with the established rash of Henoch-Schönlein purpura.
  • Perforated appendicitis is a potential, albeit rare, complication in children with HSP.
  • Distinguishing appendicitis from other abdominal pain causes in HSP requires vigilance.

Implications:

  • Clinical vigilance and serial examinations are crucial for accurate diagnosis in HSP patients with abdominal pain.
  • Diagnostic imaging, including ultrasonography, aids in differentiating surgical conditions from HSP symptoms.
  • Avoiding unnecessary surgical interventions in suspected appendicitis cases within the HSP spectrum is important.

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