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Central Nervous System Involvement in Henoch-Schonlein Purpura in Children and Adolescents

Iliyana H Pacheva1, Ivan S Ivanov1, Krastina Stefanova1

  • 1Department of Pediatrics and Medical Genetics, Medical University-Plovdiv, Plovdiv, Bulgaria.

Case Reports in Pediatrics
|March 21, 2017
PubMed

Insights

Central nervous system involvement in Henoch-Schonlein purpura (HSP) is rare. This study found one case of Posterior Reversible Encephalopathy Syndrome (PRES) in 112 children with HSP, highlighting the need for clinical awareness.

Area of Science:

  • Pediatrics
  • Neurology
  • Rheumatology

Background:

  • Henoch-Schonlein purpura (HSP) is a common childhood vasculitis.
  • Central nervous system (CNS) involvement in HSP is infrequent but challenging to diagnose.
  • Posterior Reversible Encephalopathy Syndrome (PRES) is a rare neurological complication.

Observation:

  • A retrospective study analyzed 112 children diagnosed with HSP between 2009-2013.
  • One 8-year-old girl presented with atypical HSP, including abdominal pain, rash, hypertension, and neurological symptoms.
  • Neurological manifestations included visual disturbances, seizures, hemiparesis, and confusion, consistent with PRES.

Findings:

  • Central nervous system involvement occurred in 0.9% of pediatric HSP cases.
  • The CNS involvement presented as Posterior Reversible Encephalopathy Syndrome (PRES), potentially linked to vasculitis or hypertension.
  • Neuroimaging revealed characteristic occipital lobe lesions, which resolved completely with clinical improvement.

Implications:

  • HSP should be considered as a potential cause of PRES in pediatric patients.
  • Early recognition and management of PRES in HSP are crucial to prevent diagnostic and therapeutic delays.
  • Increased clinical awareness of this rare complication can improve patient outcomes.

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