Henoch-Schönlein Purpura Associated with Gangrenous Appendicitis: A Case Report
Journal name: The Malaysian Journal of Medical Sciences
Original article title: Henoch-Schönlein Purpura Associated with Gangrenous Appendicitis: A Case Report
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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NK SEMEENA, Shashikant ADLEKHA
The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: Henoch-Schönlein Purpura Associated with Gangrenous Appendicitis: A Case Report
Year: 2014
Copyright (license): CC BY 4.0
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Summary of article contents:
Introduction
Henoch-Schönlein Purpura (HSP) is a type of leucocytoclastic vasculitis characterized by non-traumatic, symmetrical purpura primarily affecting the lower limbs and buttocks. Additional symptoms may include arthritis, gastrointestinal issues, and occasionally nephritis. A case is reported involving a 35-year-old male who presented with symptoms including a purpuric rash on the lower extremities, fever, abdominal pain, and gastrointestinal bleeding, culminating in a diagnosis of HSP associated with acute appendicitis, a rare complication of this condition.
Systemic Manifestations of HSP
HSP primarily manifests through systemic hypersensitivity, leading to symptoms such as abdominal pain, polyarthralgia, and, in severe cases, acute glomerulonephritis. The disease often affects small blood vessels and typically presents initially with abdominal symptoms, complicating diagnosis by mimicking appendicitis or other gastrointestinal issues, which may lead to unnecessary surgical interventions. In this case, after presenting with abdominal pain and a rash, diagnostic evaluations, including blood tests and a skin biopsy, confirmed the diagnosis of HSP. Surgical intervention was required due to appendicitis, where the histopathological examination revealed a gangrenous appendix. Though the abdominal symptoms resolved post-surgery, the purpuric lesions persisted for some time before eventually healing completely.
Conclusion
HSP is a multisystem vascular disorder with a high potential for complications, especially in the musculoskeletal, gastrointestinal, and renal systems. The complexity of its manifestations often necessitates careful clinical evaluation and imaging to avoid unnecessary surgeries, particularly in cases resembling acute appendicitis. Early identification and management play a critical role in patient outcomes, underscoring the importance of thorough assessments to mitigate complications associated with HSP and improve prognosis. Regular monitoring following surgical intervention is also essential due to the possibility of recurrence.
FAQ section (important questions/answers):
What is Henoch-Schönlein Purpura (HSP)?
Henoch-Schönlein Purpura (HSP) is a type of vasculitis characterized by purpuric rash, arthritis, abdominal pain, and, in rare cases, nephritis. Its exact cause is unclear, but it primarily affects small blood vessels.
What symptoms did the 35-year-old male patient experience?
The patient presented with purpuric rash on his lower extremities, fever, abdominal pain, arthralgia, and melaena. He also had swelling in his left ankle joint after a week of varied symptoms.
How was the diagnosis of HSP with appendicitis confirmed?
Diagnosis involved clinical examination revealing purpuric lesions, blood tests showing mild leukocytosis, and imaging revealing an inflamed appendix. A biopsy indicated leucocytoclastic vasculitis, confirming HSP.
What were the outcomes after the patient's treatment?
After appendectomy, the patient's abdominal pain and fever resolved, but purpuric lesions persisted for 16 days. Recurrence of symptoms occurred two months post-surgery, but he recovered completely with treatment.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Henoch-Schönlein Purpura Associated with Gangrenous Appendicitis: A Case Report”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Pain:
Pain is a significant symptom often associated with Henoch-Schönlein Purpura (HSP), manifesting as abdominal pain, swelling of joints, and associated discomfort. It indicates underlying inflammation or vascular involvement, leading to severe discomfort and affecting the patient's quality of life. Pain management is crucial in the overall treatment plan for HSP.
2) Ras (Rash):
Rash, particularly purpuric rash, is a hallmark symptom of Henoch-Schönlein Purpura (HSP) and is characterized by non-blanching purple spots primarily located on the lower extremities and buttocks. Its presence is critical for diagnosis and serves as an important indicator of the underlying vasculitis affecting small blood vessels.
3) Disease:
Henoch-Schönlein Purpura (HSP) is classified as a systemic small-vessel vasculitis, affecting various organs, especially the skin, gastrointestinal tract, and kidneys. Understanding it as a disease helps in altering management approaches and guiding prognosis significantly, leading to improved patient care and outcome assessments across diverse age groups.
4) Fever:
Fever in HSP is an inflammatory response that can accompany other symptoms like abdominal pain and rash. It signals infection or systemic involvement and may complicate the clinical presentation. Managing fever becomes essential in the treatment approach to ensure comfort and overall recovery for the patient.
5) Bleeding:
Bleeding, especially gastrointestinal bleeding, can occur in Henoch-Schönlein Purpura due to vascular inflammation, leading to complications. Its identification through positive stool tests for occult blood is crucial as it may require urgent evaluation and intervention, enhancing the understanding of the severity of the patient's condition and guiding treatment.
6) Table:
The term 'Table' refers to the organized presentation of clinical findings or data related to Henoch-Schönlein Purpura in medical literature. It serves to summarize information, allowing clinicians and researchers to quickly grasp important details about symptoms, diagnosis criteria, and treatment approaches, which aids in effective patient management.
7) Blood:
Blood plays a pivotal role in the diagnosis and monitoring of Henoch-Schönlein Purpura. Routine blood tests reveal abnormalities such as leukocytosis or elevated erythrocyte sedimentation rates, indicating inflammation. Understanding blood changes aids in assessing the severity of the disease and guiding appropriate interventions and treatment strategies.
8) Seth:
Seth is mentioned as one of the authors contributing to the body of research regarding Henoch-Schönlein Purpura. Recognizing authors enhances academic credibility and encourages further exploration of their findings. The collaborative work helps to advance understanding of the disease, its complications, and management strategies in the medical community.
9) Sign:
Sign refers to the clinical manifestations observed in patients with Henoch-Schönlein Purpura, such as the characteristic purpuric rash and joint swelling. Identifying these signs is vital for diagnosis, aiding healthcare professionals in distinguishing HSP from other conditions that share similar symptoms and ensuring timely and effective treatment.
10) Discussion:
Discussion refers to the section in medical reports where findings and implications of Henoch-Schönlein Purpura are analyzed. It is crucial for interpreting clinical data, exploring complications, and understanding treatment outcomes. Engaging in discourse enhances knowledge and can lead to improved practices and patient care in managing the disease.
11) Vomiting:
Vomiting is a symptom that could present in patients with Henoch-Schönlein Purpura, especially if gastrointestinal involvement leads to distress. Although not always prevalent, identifying episodes of vomiting is essential for evaluating the severity of the disease and the potential need for additional medical interventions to alleviate discomfort.
12) Swelling:
Swelling, particularly in joints, is a common manifestation of Henoch-Schönlein Purpura due to inflammation associated with small-vessel vasculitis. Recognizing and assessing swelling contributes to accurate diagnosis and treatment planning, as it affects mobility and quality of life, necessitating appropriate therapeutic approaches to manage symptoms effectively.
13) Surface:
Surface refers to the areas of the body where the purpuric rash typically appears in Henoch-Schönlein Purpura. Often localized to the lower extremities and buttocks, understanding surface manifestations is essential for clinicians when performing physical examinations, as they can guide the diagnosis and highlight other systemic involvement in the disease.
14) Nature:
Nature describes the characteristics and complexities of Henoch-Schönlein Purpura as a multisystem disorder involving immune-mediated mechanisms. Understanding the nature of HSP is crucial for clinicians and researchers in recognizing its variable presentation, complications, and therapeutic considerations necessary for effective patient management and improving clinical outcomes.
15) Indian:
Indian likely refers to the traditional Ayurvedic treatments the patient utilized, illustrating the cultural and regional diversity in medical approaches. Recognizing the impact of such treatments can enhance understanding of patient backgrounds, inform alternative management strategies, and guide healthcare professionals in addressing concerns comprehensively during treatment.
16) Study (Studying):
Study denotes the analysis or research conducted on Henoch-Schönlein Purpura to gather insights into its pathophysiology, clinical presentation, and treatment outcomes. Engaging in studies influences evidence-based practices, fosters ongoing research endeavors, and provides updated knowledge that recognizes the evolving landscape of HSP management in clinical settings.
17) Post:
Post refers to the period following surgical interventions, such as appendectomy in this context. Understanding post-operative care and monitoring is essential to address ongoing symptoms like purpuric lesions, guiding further patient assessments and adjustments in treatment strategies to ensure comprehensive care during recovery phases.
18) Male:
Male indicates the demographic characteristics of a patient with Henoch-Schönlein Purpura as illustrated in the case report. Understanding male gender prevalence in certain conditions helps in researching and tabulating epidemiological data, enhancing awareness of gender factors influencing disease patterns, manifestations, and responses to treatment.