Henoch-Schonlein Purpura (HSP) or Anaphylactoid Purpura

  • Medical Author:
    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Henoch-Schonlein purpura (HSP) facts

  • Henoch-Schonlein purpura is a particular form of blood vessel inflammation called vasculitis.
  • Henoch-Schonlein purpura frequently follows an infection of the throat or breathing passages, but it can be induced by certain medications.
  • Henoch-Schonlein purpura causes skin rash, pain in the abdomen, and joint inflammation (arthritis).
  • The treatment of Henoch-Schonlein purpura is directed toward the most significant area of involvement.
  • The prognosis for patients with Henoch-Schonlein purpura is generally excellent.

What is Henoch-Schonlein purpura (HSP)?

Henoch-Schonlein purpura (HSP) is a form of blood vessel inflammation or vasculitis. There are many different conditions that feature vasculitis. Each of the forms of vasculitis tends to involve certain characteristic blood vessels. HSP affects the small vessels called capillaries in the skin and frequently the kidneys. HSP results in a purplish skin rash (most prominent over the buttocks and behind the lower extremities) associated with joint inflammation (arthritis) and sometimes cramping pain in the abdomen. Henoch-Schonlein purpura is also referred to as anaphylactoid purpura.

What causes HSP?

HSP occurs most often in the spring season and frequently follows an infection of the throat or breathing passages. HSP seems to represent an unusual reaction of the body's immune system that is in response to this infection (either bacteria or virus). Aside from infection, drugs can also trigger the condition. HSP occurs most commonly in children, but people of all age groups can be affected, including adults.

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Vasculitis symptoms

What are the symptoms of vasculitis?

The symptoms of vasculitis vary greatly from person to person, and depend upon the organs affected and the severity.

  • Generally vasculitis causes fatigue and malaise.
  • Sometime vasculitis can lead to weakness and weight loss.
  • Vasculitis affecting the skin can cause rashes, skin discoloration, and ulcers.
  • Vasculitis affecting the muscles can cause muscle pain.
  • Vasculitis affecting the lungs can cause shortness of breath and cough.
  • Vasculitis affecting the heart can cause congestive heart failure.
  • Vasculitis affecting the brain can cause headaches, confusion, seizures, stroke, paralysis, numbness, and lightheadedness.
  • Vasculitis affecting the kidneys can cause kidney failure.

What are risk factors for HSP?

The only known risk factors for HSP are exposure to certain viruses and drugs. The reaction to these agents that leads to HSP is not, however, predictable.

What are HSP symptoms and signs?

Classically, HSP causes a purple-appearing skin rash, pain in the abdomen, and joint inflammation (arthritis). Not all features need be present for the diagnosis. The rash of skin lesions appears in gravity-dependent areas, such as the legs. The joints most frequently affected with pain and swelling are the ankles and the knees. Patients with HSP can develop fever. Inflammation of the blood vessels in the kidneys (nephritis) can cause blood and/or protein in the urine. Abdominal pain and gastrointestinal bleeding is more common in children than in adults. Serious kidney complications are infrequent but can occur.

Symptoms usually last approximately a month. Recurrences are not frequent but do occur.

How is HSP diagnosed?

HSP is usually diagnosed based on the typical skin, joint, and kidney findings. Throat culture, urinalysis, and blood tests for inflammation and kidney function are used to suggest the diagnosis. A biopsy of the skin, and less commonly kidneys, can be used to demonstrate vasculitis. Special staining techniques (direct immunofluorescence) of the biopsy specimen can be used with microscopic examination to document antibody deposits of IgA in the blood vessels of involved tissue.

What is the treatment for HSP?

While HSP is generally a mild illness that resolves spontaneously, it can cause serious problems in the kidneys and bowels. The rash can be very prominent, especially on the lower extremities.

The treatment of HSP is directed toward the most significant area of involvement. Joint pain can be relieved by anti-inflammatory medications such as aspirin or ibuprofen (Motrin). Some patients can require cortisone medications, such as prednisone or prednisolone, especially those with significant abdominal pain or kidney disease. With more severe kidney disease, involvement called glomerulonephritis or nephritis, cyclophosphamide (Cytoxan), azathioprine (Imuran), or mycophenolate mofetil (Cellcept) have been used to suppress the immune system. Infection, if present, can require antibiotics.

What are complications of HSP?

HSP can have complications, which generally occur more frequently in children than in adults. These complications include severe abdominal pain and gastrointestinal bleeding. Adults can have extended kidney problems.

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What is the prognosis for patients with HSP?

The prognosis (outlook) for patients with HSP is generally excellent. Nearly all patients have no long-term problems. The kidney is the most serious organ involved when it is affected. Rarely, patients can have serious long-term kidney damage or an abnormal bowel folding called intussusception. Some patients have recurrences of symptoms, particularly skin rash, for months to a year after the onset of the illness.

Can HSP be prevented?

HSP can be prevented only to the extent that one minimizes exposure to viruses and certain drugs that could cause the abnormal immune response. As it is impossible to know who will get HSP, it is not possible to actually prevent it.

Medically reviewed by Robert J. Bryg, MD; Board Certified Internal Medicine with subspecialty in Cardiovascular Disease

REFERENCES:

Klippel, John H., et al., eds. Primer on the Rheumatic Diseases. 13th ed. New York: Springer and Arthritis Foundation, 2008.

Ruddy, Shaun, et al., eds. Kelley's Textbook of Rheumatology. Philadelphia: W.B. Saunders Co., 2000.

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Reviewed on 3/7/2016
References
Medically reviewed by Robert J. Bryg, MD; Board Certified Internal Medicine with subspecialty in Cardiovascular Disease

REFERENCES:

Klippel, John H., et al., eds. Primer on the Rheumatic Diseases. 13th ed. New York: Springer and Arthritis Foundation, 2008.

Ruddy, Shaun, et al., eds. Kelley's Textbook of Rheumatology. Philadelphia: W.B. Saunders Co., 2000.

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