Her temperature is 37°C, pulse rate is 100 beats/min, respiratory rate is 18 breaths/min, and blood pressure is 88/60 mm Hg. Findings on examination are normal with the exception of her skin (, ). Results of the girl’s complete blood cell count, renal function panel, and urinalysis are all unremarkable. Of the following, the MOST appropriate initial management of this patient includes A. analgesics and weekly urine dipsticks B. ceftriaxone and isotonic saline C. methylprednisolone and nephrology consultation D. prednisolone and weekly renal function panels E. triamcinolone ointment and antihistamines Correct Answer: A The girl in the vignette has a history and examination consistent with Henoch-Schönlein purpura (HSP) and no evidence of nephritis or other complication. Management of uncomplicated cases of HSP is supportive and focused on pain control and maintenance of hydration. Follow-up urine tests should be performed through the first 3 months after diagnosis to screen for the development of nephritis. Systemic steroid therapy has been shown to improve pain in severe cases and is generally reserved for severe joint or abdominal pain. This patient’s course and examination are not consistent with an infectious etiology and therefore antibiotics are not indicated. Topical steroids and antihistamines have no role in the management of HSP. Henoch-Schönlein purpura, formally known as anaphylactoid purpura, is the most common vasculitis in childhood; it is a small-vessel necrotizing vasculitis that was first described in 1801. The term anaphylactoid was coined by William Osler in 1914, when he proposed that HSP was the result of an anaphylactic reaction; it is now known that anaphylaxis does not play a role in the pathogenesis of HSP. Although HSP can occur at any age, it most commonly occurs between the ages of 3 and 5 years, with 50% of cases occurring before 5 years and 90% before 10 years of age. HSP is most
Her temperature is 37°C, pulse rate is 100 beats/min, respiratory rate is 18 breaths/min, and blood pressure is 88/60 mm Hg. Findings on examination are normal with the exception of her skin (, ). Results of the girl’s complete blood cell count, renal function panel, and urinalysis are all unremarkable. Of the following, the MOST appropriate initial management of this patient includes A. analgesics and weekly urine dipsticks B. ceftriaxone and isotonic saline C. methylprednisolone and nephrology consultation D. prednisolone and weekly renal function panels E. triamcinolone ointment and antihistamines Correct Answer: A The girl in the vignette has a history and examination consistent with Henoch-Schönlein purpura (HSP) and no evidence of nephritis or other complication. Management of uncomplicated cases of HSP is supportive and focused on pain control and maintenance of hydration. Follow-up urine tests should be performed through the first 3 months after diagnosis to screen for the development of nephritis. Systemic steroid therapy has been shown to improve pain in severe cases and is generally reserved for severe joint or abdominal pain. This patient’s course and examination are not consistent with an infectious etiology and therefore antibiotics are not indicated. Topical steroids and antihistamines have no role in the management of HSP. Henoch-Schönlein purpura, formally known as anaphylactoid purpura, is the most common vasculitis in childhood; it is a small-vessel necrotizing vasculitis that was first described in 1801. The term anaphylactoid was coined by William Osler in 1914, when he proposed that HSP was the result of an anaphylactic reaction; it is now known that anaphylaxis does not play a role in the pathogenesis of HSP. Although HSP can occur at any age, it most commonly occurs between the ages of 3 and 5 years, with 50% of cases occurring before 5 years and 90% before 10 years of age. HSP is most
prep-e-med-2013.docx