Unusual manifestations of henoch-schonlein purpura

Henoch schonlein syndrome (HSP) represents a diagnostic challenge when gastrointestinal symptoms or other atypical symptoms precede the cutaneous manifestations. We describe two patients whose abdominal symptoms antedated cutaneous manifestations. Six-year-old, black male patient, presented with 1 wk history of vomiting (without diarrhea or urinary symptoms), hypertension (140/90 mmHg), diffuse abdominal pain and hypoactive bowel sounds:. WBC's 40,000/Cu mm³ with 80 percent hypoproteinemia, (albumin 1.6 G%), high plasma renin and stools positive for occult blood. Renal function and urinalysis was normal. Two weeks later patient developed urticarial purpuric rash over the ankles, gross hematuria and gross edema. Biopsy of the skin lesion was consistent with HSP vasculitis. Second patient 4 yr Brazilian male patient presented with abdominalpain, vomiting, blood in the stools, and pain in the right testis. Three days later, developed purpuric rash over his limbs and trunk. He also had hypoproteinemia, hypoalbuminemia, leukocytosis and normal urine analysis. Abdominal pain, bloody stools, painful testicular swelling and hypoproteinemia abated with steroid therapy. In HSP patients, atypical presentation of abdominal pain, hypertension, hypoproteinemia without proteinuria testicular swelling and leucocytosis in the absence of cutaneous and joint manifestations poses as diagnostic problem. Protein-losing enteropathy should be considered in HSP patients with hypoproteinemia.