A four-year-old girl presented to the emergency department with a purpura rash palpable in the lower limbs and glueos, pain and swelling in the left ankle and the second finger of the right hand.
As a history, the week prior to the onset of symptoms had acute pharyngitis.
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Investigations:
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Microbiology: rapid detection of group A β -agonist negative, urocultive sterile, hemocultive negative.
Blood count: leukocytes 8320/mm3, hemoglobin 13 g/dl, platelets 276,000/mm3, erythrocyte sedimentation rate (GSR) in the first hour of 18 mm/h.
Coagulation tests: prothrombin time of 13.9 seconds (range 10-14), Quick index 69% (range 70-150), international normalized ratio (INR) 1.25 (range 0.85 to 1.15), activated thromboplastin time.
Biochemistry: glucose 82 mg/dl, urea 20 mg/dl, creatinine 0.40 mg/dl, total/direct bilirubin 0.4/0.2 mg/dl, total protein 7.5 g/dl, total calcium TG/15 g/dl
Ion: Na 130 mEq/l, K 3.5 mEq/l, Cl 103 mEq/l.
C-reactive protein 1.05 mg/dl.
No significant proteinuria or hematuria was observed.
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Due to the clinical characteristics, the case suggests as first possibility a Schönlein-Henoch purpura with joint involvement.
The case evolved satisfactorily with nonsteroidal anti-inflammatory drugs and rest.
