Thrombosis Warning in Children Suffering from Henoch-Schonlein Purpura
A 14-year-old boy with no significant past medical or family history was admitted to our hospital complaining of abdominal pain for the previous 14 days. He had passed dark red and black stool for 7 days, and had an erythematous rash over the anterior aspect of the lower legs for 2 days with a day of bilateral ankle arthralgia. On general examination, his vital signs were stable and he had a palpable purpuric rash that predominantly affected the anterior aspect of his lower legs []; the bilateral ankles were swollen. Abdominal examination revealed generalized tenderness that was more obvious in the supraumbilical region. Per rectal examination revealed dark red stool. The fecal occult blood test was positive.\nThe laboratory results were as follows: hemoglobin level: 14.5 g/dL; leucocyte count: 25.27 × 109/L with 81% polymorphonuclear leukocytes; lymphocyte count: 13%; platelet count: 492/mm3. Serum electrolytes, blood urea nitrogen and creatinine, liver function tests, urine analysis, erythrocyte sedimentation rate, antinuclear antibody and anticardiolipin antibody levels and the coagulation profile were all within their normal ranges. An abdominal computed tomography (CT) scan showed thickening of the proximal small intestinal wall with a peritoneal effusion. The mesenteric CT venography was reported as a suspected SMV thrombosis with edema of the proximal intestinal wall [].\nAccording to the clinical manifestations, laboratory results and radiological findings, the patient was diagnosed with HSP and suspected SMV thrombosis. He was treated with mezlocillin sodium, methylprednisolone and heparin. After 7 days, his abdominal pain resolved and a repeated abdominal CT scan revealed that the intestinal wall edema and peritoneal accumulation had improved. On the 10th day of hospitalization, follow-up CT venography revealed homogeneous contrast throughout the SMV and no signs of venous thrombosis []. The pat ient had no abdominal pain, no new rash and no swollen joints. He was discharged from hospital on the 12th day of admission. During the 2-month follow-up period, he had no new complaints.