[醫如往常] Junior Clerkship Day 36: Henoch-Schönlein purpura, Child seizure

20151022Morning meeting: Henoch-Schönlein purpura

1.  過敏性紫斑症，是一種 vasculitis syndrome
2.  主要的症狀有三種，為此病的 clinical triad
(1)  Abdominal pain：由於mesenteric artery ischemic所產生的劇痛，
又可能伴隨 vomiting 和 bloody stool。
（有可能會痛到被認為是盲腸炎，結果小兒外科抓去開刀，隔天冒出了不會痛的疹子，才發現是此病） ischemic pain
(2)  Skin rash：在下肢和臀部有「壓了不會退」的疹子，代表是因血管炎而起
(3)  Arthritis
3.  How to rule out:
(1)  病史詢問時並沒有問到曾發生過痛到不行的肚子痛。
(2)  PE  時下肢也沒有出現壓不退的出血點。
(3)  以上兩個都是 HSP  在小孩發生時常見的症狀，因此若沒有的話則 HSP  的可能性不高。

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Dr. Chen (intern)
秋冬常見
男多於女

也許跟infection有關
Unblemished, macule, big, purpura

Intussusception比較特別是小腸套小腸

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Diagnostic Criteria

American College of Rheumatology, 1990

Presence of two or more of the following:

• Palpable purpura without thrombocytopenia 

• Patient 20 years or younger at disease onset 

• Bowel angina (diffuse abdominal pain or diagnosis of bowel ischemia)

• Biopsy showing granulocytes in the walls of small arterioles or venules

International Consensus Conference, 2006

Palpable purpura in the presence of one or more of the following:

• Diffuse abdominal pain

• Any biopsy showing predominant immunoglobulin A deposition

• Arthritis (acute, any joint) or arthralgia

• Renal involvement (any hematuria or proteinuria)

Symptoms & Signs

Mild leukocytosis

Elevated IgA levels 

Skin or renal biopsy for IgA deposition

Thrombocytopenia suggests alternate diagnosis

microscopic or gross hematuria

Potential Complications

Severe scrotal edema may cause testicular torsion

 myocardial infarction, pulmonary hemorrhage, or central nervous system involvement with seizures and hemorrhage

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DDX

Thrombocytopenic purpura: end-organ ischemia, rash也長得不一樣

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Ref. 

October 1, 2009  ◆  Volume 80, Number 7     www.aafp.org/afp      American Family Physician  699-703

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Child seizure 

Chief. Lee AP

Epileptic seizure

At least 2 seizures occurring >24 hr apart

治療3-5年才能停藥

十年不復發才稱痊癒

Focal（partial）seizures

Simple,  Complex跟預後無關，主要依 consciousness 有無分