Case Study: Lower Extremity Rash and Abdominal Pain


The image shows dependent, palpable purpura consistent with Henoch-Schönlein purpura (HSP). Urinalysis should be sent to confirm no renal complications are present.

HSP is a vasculitic disease of unknown etiology that most commonly occurs in winter or spring. The condition is characterized by a rash and joint pain that most commonly affect the lower extremities. Abdominal pain is also often present. The condition often develops following a viral infection such as the common cold. The rash is typically palpable, lower extremity purpura, but the color may be more pink or red than purple and may not occur until days after abdominal or joint pain develops.

Urinalysis may demonstrate hematuria, and occult blood in the stool may be present. Laboratory testing may reveal an elevated white blood cell count or erythrocyte sedimentation rate. Platelet count and coagulation studies should be normal and can help to rule out more dangerous conditions such as meningococcemia or Rocky Mountain spotted fever.

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Complications from HSP are rare but may include glomerulonephritis, gastrointestinal bleeding, intussusception, and, in rare cases, intracranial bleeding or seizures. Treatment is typically nonsteroidal anti-inflammatory medication or acetaminophen for pain, and discharge home. For more complicated cases, steroids and admission are recommended.

The patient was discharged home with acetaminophen and diphenhydramine hydrochloride as needed. During a telephone follow-up, the patient stated that the symptoms worsened on the initial day of treatment, but her condition began to improve in the following days.

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Pregerson DB. Emergency Medicine 1-Minute Consult Pocketbook. 2017;5.

This article originally appeared on Clinical Advisor