The presence of purpura is a compulsory criteria for the diagnosis of Henoch-Schönlein purpura (HSP). Typical purpura of HSP is distributed symmetrically over the extensor surfaces of the lower limbs, buttocks, and forearms with the occasional involvement of trunk and face in children. It occurs only involving the bottom of the feet has never been reported.
A 7-year-old girl was admitted to the hospital with abdominal pain, vomiting, and fever.
Combining clinical manifestations with results of radiologic examinations, acute appendicitis was suspected and a laparotomy was considered. Purpura was found on the bottom of her feet when she was in the operating room and HSP was diagnosed.
The patient was treated with glucocorticosteroids, antibiotics, cimetidine, and restriction of feeding.
The abdominal pain and purpura resolved at discharge and there were no recurrences in the subsequent 3-, 6-, and 12-month follow-ups.
Careful examination of skin including the bottom of the feet can help to direct the diagnostic workup for children with abdominal pain.
aDepartment of Neonatology
bDepartment of Laboratory, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Correspondence: Kewen Jiang, Department of Laboratory, Children's Hospital, Zhejiang University School of Medicine, 3333 Binsheng Road, Hangzhou 310052, China (e-mail: email@example.com).
Abbreviations: CT = computed tomography, GCSs = glucocorticosteroids, HSP = Henoch-Schönlein purpura, IgA = immunoglobulin A.
Written informed consent was obtained from the guardian of the patient in this case report.
The authors have no conflicts of interest to disclose.
Funding: This publication was supported by the National Natural Science Foundation of China 81571263, 81871012 and 81300975), the Zhejiang Provincial Technology Plan (2015C37105), and by the Key Laboratory of Reproductive Genetics (Zhejiang University), Ministry of Education, and the Key Laboratory for Diagnosis and Therapy of Neonatal Diseases of Zhejiang Province.
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Received July 31, 2018
Accepted October 24, 2018