Vasculitis
IgA-Mediated Vasculitis (Henoch-Schönlein Purpura)
Aetiology:
Often follows a preceding infection
Clinical Features:
Skin:
Symmetrical macular rash (purpura), typically on the lower limbs
Gastrointestinal:
Colicky abdominal pain
Haematochezia (blood in stool)
Intussusception occurs in 3-4% of cases
Lower GI bleeding in 25% of cases
Endoscopic findings may include mucosal oedema, patchy erythema, and multiple gastric erosions
Lesions are more severe in the duodenal bulb and the second part of the duodenum
Biopsies show neutrophilic infiltrates, especially in the lamina propria
Renal:
Haematuria, which can progress to chronic kidney disease (CKD)
Joints:
Joint pain (arthralgia)
Diagnosis:
Clinical diagnosis
Investigations are performed to rule out other potential causes
Management:
Self-limiting condition
Steroids may be beneficial for managing arthralgia
Kawasaki Disease
Aetiology:
Unknown
Pathophysiology:
Vasculitis affecting medium-sized arteries
Clinical Features:
Coronary artery aneurysms (most serious complication)
Purulent conjunctivitis
Rash
Changes in lips and oral cavity (e.g., strawberry tongue, red cracked lips)
Changes in peripheral extremities (e.g., erythema, peeling skin)
Cervical lymphadenopathy
Mucocoele gallbladder (enlarged, inflamed gallbladder)
Diagnosis:
Clinical diagnosis based on the characteristic signs and symptoms
Management:
Focus is on preventing cardiac complications
Intravenous immunoglobulin (IVIg) and aspirin as first-line treatments
Corticosteroids, infliximab, and cyclosporine A may be used for resistant cases
References
Roache-Robinson P, Killeen RB, Hotwagner DT. IgA Vasculitis (Henoch-Schönlein Purpura) [Updated 2023 Sep 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537252/
Owens AM, Plewa MC. Kawasaki Disease. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537163/