This patient has the constellation of symptoms including palpable purpura, joint pain, abdominal pain, and renal disease that lead to the diagnosis of Henoch-Schonlein purpura (HSP).
HSP is a IgA-mediated small vessel vasculitis that is commonly seen in the pediatric population after upper respiratory tract infections. The triad of symptoms including joint pain, abdominal pain, and purpura is classic for this diagnosis. Treatment is usually supportive in nature as most cases resolve on their own. Steroids can be used in severe cases. Intusseception is a late sequelae of HSP.
Reamy et al. discuss the management of HSP. They state the majority of cases do resolve with supportive treatment only. A recent meta-analysis has shown that the initiation of low dose steroid treatment can reduce the time to resolution of abdominal pain and decrease the chance of a persistent renal deficiency.
Dudley et al. present a randomized, double-blind, placebo-controlled trial examining the effect of early low dose steroid treatment on 12 month renal function in patients with HSP. They found no evidence that early steroid treatment reduces the prevalence of proteinuria at the 12 month time point.
Figure A displays the purpuric rash that was seen in this patient.
Answer 1: Kawasaki's disease is a medium vessel vasculitis that classically presents with a desquamating rash, swelling of the hands and feet, cervical adenopathy, and a "strawberry tongue."
Answer 3: Minimal change disease is the most common nephrotic syndrome in children, but it unlikely to present with these other symptoms.
Answer 4: Measles commonly presents with a fever and a generalized erythematous maculopapular rash.
Answer 5: The characteristic rubella rash starts on the face and spreads to the body and limbs.
Reamy BV, Williams PM, Lindsay TJ. Henoch-Schönlein purpura. Am Fam Physician. 2009 Oct 1;80(7):697-704.
PMID:19817340 (Link to Abstract)
Dudley J, Smith G, Llewelyn-Edwards A, Bayliss K, Pike K, Tizard J. Randomised, double-blind, placebo-controlled trial to determine whether steroids reduce the incidence and severity of nephropathy in Henoch-Schonlein Purpura (HSP). Arch Dis Child. 2013 Oct;98(10):756-63.
PMID:23845696 (Link to Abstract)