1
Q
IGA VASCULITIS
What are the features of IgA vasculitis?
How would you diagnose?
A
IgA vasculitis aka Henoch Schonlein Purpura (HSP) has the following tetrad:
- Palpable purpura (without thrombocytopenia or coagulopathy) - gravity-dependent –> lower extremities
- Joints - arthralgia/ arthritis
- Abdominal pain
- Kidney disease
Primarily occurs in childhood: age 3-15.
Diagnosis:
Urinalysis, FBC, EUC, Coags
- Urinalysis and EUC –> may show kidney dysfunction
- Normal platelets, normal coags
Diagnosis confirmed by biopsy -
- Usually skin (or kidney if severe kidney dysfunction)
Consider abdominal imaging if significant abdo symptoms/signs
2
Q
What are you DDX for a child with a purpuric rash?
A
- Trauma –> non-accidental (child abuse), accidental, iatrogenic (e.g. procedure, tourniquet)
- Infection –> N. meningitidis (also: S pneumonia, GAS, S aureus, enterovirus, adenovirus, influenza)
- Haematological –> thrombocytopenia:
- – Immune thrombocytopenia (ITP)
- – Haemolytic uremic syndrome (HUS)
- – Malignancy - acute leukemia
- – Aplastic anaemia/ myelodysplasia
- – DIC
- – Drug-induced thrombocytopenia
- Vasculitis –> IgA vasculitis
3
Q
How would you further investigate an abnormal neurodevelopmental exam?
A
Urine metabolic study TSH Brain imaging Genetic study Formal neurodevelopmental assessment
4
Q
What are the causes of failure to thrive?
A
1 PARENTAL
- Social: low SES, poor education
- Emotional: MH, post-partum depression
- D&A
2 CHILD Decreased supply - FEEDING: poor breast milk supply, cleft lip, oral motor dysfunction - ABSORPTION: GIT disease Increased demand - INCREASED BMR: hyperthyroidism - CHRONIC DISEASE
