Introduction
Henoch-Schönlein purpura (HSP) is a vasculitis that involves small vessels and seen in children predominantly. Main symptoms are purpuric rashes on body, especially on lower extremities, arthralgia, abdominal pain, and nephritis. Uncommonly, nervous system can be involved.
Objectives
PRES can occur in HSP infrequently. Here we will review our case, a first reported Korean case, and compare with published cases to find out which symptoms and signs should be aware.
Methods
First, our case is reviewed retrospectively by electrical medical record. And then, we searched Pubmed database, terms including HSP, PRES, RPLS, and encephalopathy. We compared collected cases and our case.
Results
A 8-year-old girl visited our hospital complaining abdominal pain and purpuric rash on lower extremities and buttock. On hospital day 7, there were two brief events of generalized tonic-clonic seizure. She complained dizziness and blurred vision. Brain MRI demonstrated increased signal intensity in the cortex and subcortical white matter, in the parietooccipital area, and impression was PRES. She was discharged on day 19 without any complication. Table 1.
Table 1.
| Age | Sex | Main symptom | Neurologic symptom | Blood pressure | Thrapy | |
|---|---|---|---|---|---|---|
| Our case | 8yr | F | Abdominal pain, Blood tinged stool, Purpura | GTC, Blurred vision | 144/86 | MPT pulse Tx, anti-hypertensive drug, anti-convulsive drug |
| Dasarathi, et al. | 11yr | F | Abdominal pain, vomiting, purpura | GTC, complete loss of vision | 112/67 | supportive Tx |
| Sivrioglu, et al. | 5yr | F | purpura, arthralgia, abdominal pain | headache seizure | 180/110 | anti-hypertensive drug, anti-convulsive drug, dialysis |
| Sasayama, et al. | 13yr | F | abdominal pain, purpura | generalized seizure, cortical blindness | 180/120 | MTP pulse Tx, anti-hypertensive drug |
| Fuchigami, et al. | 7yr | F | abdominal pain, arthralgia, purpura | sudden loss of vision GTC | 190/100 | PL, anti-hypertensive drug, anti-convulsive drug |
| Woolfenden et al. | 10yr | M | fever, RLQ pain, bloody diarrhea | Bi-temporal headache, nausea, vomiting bilateral visual loss seizure | not known | MTP pulse Tx, anti-convulsion drug |
| Ozcakar et al. | 10yr | M | fever, palpable purpra, arthralgia | seizure | 130/90 | steroid, anti-convulsive Tx, anti-hypertension drug |
| Endo et al. | 7yr | F | abdominal pain, purpura | seizure unconsciousness loss of vision | 190/100 | PL, anti-hypertensive drug, anti-convulsive drug |
Conclusion
In HSP patients, hemodynamic change due to severe hypertension and renal insufficiency, and CNS vasculitis can cause PRES. JI Shin suggests IL-6 and VEGF can play a role in this situation. Neurological involvement is not common in HSP. But when patients complain headache or blurred vision, it can be manifestation of CNS lesion, including PRES. Adequate assessment and manage should be performed to avoid neurologic sequela.
Disclosure of interest
None declared