Hypergammaglobulinemic purpura of Waldenström in children

Erin Theisen, Dylan E. Lee, Susan Pei, David M. Schauder, Yvonne E. Chiu, Heather Brandling-Bennett, Megan L Curran, Marisa Klein-Gitelman, Dominic O. Co, Lisa M. Arkin*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Hypergammaglobulinemic purpura of Waldenström (HGPW), a rare cutaneous eruption characterized by the triad of recurrent episodes of lower extremity petechiae, symptoms of stinging and burning, and lower extremity edema, is poorly described in children. Some children have been reported to follow a benign course, while others are eventually diagnosed with fulminant rheumatologic disease. Objectives: To determine the distinguishing features of HGPW including the spectrum of disease manifestations and clinical outcomes. Methods: This is a multicenter, retrospective case series of six children with HGPW combined with a literature review of 45 previously published pediatric cases. Results: Most children were eventually diagnosed with systemic disease (63%) or developed autoantibody accumulation suggestive of evolving disease (71%). The most common diagnoses were Sjogren's syndrome and systemic lupus erythematosus. The mean duration between onset of cutaneous eruption and diagnosis of systemic disease was 5.6 years, underscoring that HPGW patients often present with a rash that precedes the development of systemic symptoms. Conclusions: Diagnosis of HGPW should prompt initial screening for rheumatologic disease with long-term rheumatology follow-up, as the majority of patients present with evolving manifestations of systemic disease.

Original languageEnglish (US)
Pages (from-to)467-475
Number of pages9
JournalPediatric dermatology
Volume37
Issue number3
DOIs
StatePublished - May 1 2020

Keywords

  • Sjogren's syndrome
  • hypergammaglobulinemic purpura
  • hypergammaglobulinemic purpura of Waldenström

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Dermatology

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