Volume 12 Supplement 1

Proceedings of the 21st European Pediatric Rheumatology (PReS) Congress

Open Access

A case of Henoch-Schönlein purpura associated with posterior reversible encephalopathy and review of litereature

  • Kyu Yeun Kim1,
  • Mo Kyung Jung1,
  • Ki Hwan Kim2 and
  • Dong Soo Kim2
Pediatric Rheumatology201412(Suppl 1):P358

https://doi.org/10.1186/1546-0096-12-S1-P358

Published: 17 September 2014

Introduction

Henoch-Schönlein purpura (HSP) is a vasculitis that involves small vessels and seen in children predominantly. Main symptoms are purpuric rashes on body, especially on lower extremities, arthralgia, abdominal pain, and nephritis. Uncommonly, nervous system can be involved.

Objectives

PRES can occur in HSP infrequently. Here we will review our case, a first reported Korean case, and compare with published cases to find out which symptoms and signs should be aware.

Methods

First, our case is reviewed retrospectively by electrical medical record. And then, we searched Pubmed database, terms including HSP, PRES, RPLS, and encephalopathy. We compared collected cases and our case.

Results

A 8-year-old girl visited our hospital complaining abdominal pain and purpuric rash on lower extremities and buttock. On hospital day 7, there were two brief events of generalized tonic-clonic seizure. She complained dizziness and blurred vision. Brain MRI demonstrated increased signal intensity in the cortex and subcortical white matter, in the parietooccipital area, and impression was PRES. She was discharged on day 19 without any complication. Table 1.

Table 1

 

Age

Sex

Main symptom

Neurologic symptom

Blood pressure

Thrapy

Our case

8yr

F

Abdominal pain, Blood tinged stool, Purpura

GTC, Blurred vision

144/86

MPT pulse Tx, anti-hypertensive drug, anti-convulsive drug

Dasarathi, et al.

11yr

F

Abdominal pain, vomiting, purpura

GTC, complete loss of vision

112/67

supportive Tx

Sivrioglu, et al.

5yr

F

purpura, arthralgia, abdominal pain

headache seizure

180/110

anti-hypertensive drug, anti-convulsive drug, dialysis

Sasayama, et al.

13yr

F

abdominal pain, purpura

generalized seizure, cortical blindness

180/120

MTP pulse Tx, anti-hypertensive drug

Fuchigami, et al.

7yr

F

abdominal pain, arthralgia, purpura

sudden loss of vision GTC

190/100

PL, anti-hypertensive drug, anti-convulsive drug

Woolfenden et al.

10yr

M

fever, RLQ pain, bloody diarrhea

Bi-temporal headache, nausea, vomiting bilateral visual loss seizure

not known

MTP pulse Tx, anti-convulsion drug

Ozcakar et al.

10yr

M

fever, palpable purpra, arthralgia

seizure

130/90

steroid, anti-convulsive Tx, anti-hypertension drug

Endo et al.

7yr

F

abdominal pain, purpura

seizure unconsciousness loss of vision

190/100

PL, anti-hypertensive drug, anti-convulsive drug

Conclusion

In HSP patients, hemodynamic change due to severe hypertension and renal insufficiency, and CNS vasculitis can cause PRES. JI Shin suggests IL-6 and VEGF can play a role in this situation. Neurological involvement is not common in HSP. But when patients complain headache or blurred vision, it can be manifestation of CNS lesion, including PRES. Adequate assessment and manage should be performed to avoid neurologic sequela.

Disclosure of interest

None declared

Authors’ Affiliations

(1)
Pediatrics, Division of Rheumoatology, College of Medicine, Yonsei University, Severance Children’s Hospital
(2)
Pediatrics, Division of Rheumatology, College of Medicine, Yonsei University, Severance Children’s Hospital

Copyright

© Kim et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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