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Each of these patients is unwell and presented with a rash on their legs.
For each of the ten cases, study the image(s) and then answer the questions. You can click on the image to view a larger version if required.
Each case should take approximately 2 minutes to complete. There is a list of suggested further reading material at the end of the quiz.
What is the name of the skin condition?
Henoch Schonlein purpura
Histology of a punch biopsy revealed a leucocytoclastic vasculitis, and direct immunofluorescence was positive with perivascular deposition of IgA. Antisptreptolysin serology was significantly positive.
What underlying systemic disease(s) or condition is it caused by?
The underlying reason for the vasculitis was streptococcal infection, resulting in Henoch-Schönlein purpura (HSP). As is typical for HSP, the patient had a small malaena. Concern about renal function led to microscopic examination of urine, which was unremarkable.
He was treated with oral penicillin V for 10 days and provided with supportive stockings. Crops of new lesions continued to occur over the next several weeks, before resolving spontaneously.
The diagnosis of HSP is usually clinical: palpable purpura and abdominal pain arising in a child or young adult. It is a small vessel immune complex-mediated vasculitis associated with deposition of IgA.
Treatment is directed against the underlying cause when identified. It is not usually necessary to treat the skin disease with oral steroids or other immunosuppressive treatment but management of renal disease may require these.