ILLUSTRATIVE CASE
A Rare Presentation of Seizures in a Not-So-Rare Disease Henoch-Scho¨nlein Purpura Presenting With Repeated Seizures Christina Camacho, MD* and Ernest G. Leva, MD, FAAPÞþ
Abstract: Henoch-Scho¨nlein purpura represents the most common form of systemic vasculitis in children. Although a very common cause of vasculitis, seizures are a very rare complication of this disorder. We report a 5-year-old boy who presents with no other clinical symptoms of the disorder other than a seizure. By presenting this case, we hope to expand the differential diagnosis of repeated seizures to include diseases in which the pathogenesis of diseases with small vessel vasculitis such as Henoch-Scho¨nlein purpura is considered. Key Words: seizure, Henoch-Scho¨nlein purpura, small vessel vasculitis (Pediatr Emer Care 2014;30: 424Y426)
CASE A 5-year-old boy with no significant past medical history presented to an outside emergency department (ED) with a 1-week history of persistent nonbilious, nonbloody emesis, decreased appetite, and worsening abdominal pain. He had been on a recent trip to India that ended 1 month before his ED presentation. An investigation in the ED was undertaken consisting of abdominal computed tomography (CT) scan with and without contrast, complete blood cell count, complete metabolic panel, and urine analysis. Laboratory studies disclosed the following values: white blood cell count, 13.3; hemoglobin, 14 g/dL; hematocrit, 40%; platelet count, 377,000; 61% neutrophils; 21% lymphocytes; and 12% monocytes. Complete metabolic panel disclosed the following values: sodium, 129 mEq/L; potassium, 4.3 mEq/L; chloride, 92 mEq/L; and bicarbonate, 26 mEq/L. Abdominal CT scan visualized a normal appendix with no other pathology; however, a large amount of stool throughout the colon was found. He was subsequently discharged home with dietary advice and the recommendation to take MiraLAX with a diagnosis of constipation. The following day, while sitting on a toilet, he became unresponsive and was noted to have stiffening of all his extremities and both of his eyes deviating to the right. This activity reportedly lasted approximately 10 minutes. This episode was noted to resolve spontaneously, but because of increased confusion and sleepiness, he was taken by the emergency medical services to a local hospital for evaluation. On admission to the ED, he was noted to have a temperature of 97.4 F/36.3-C, blood pressure of 143/96 mm Hg, heart rate of 94, and an oxygen saturation of 99% on room air. Physical examination revealed dry mucous From the *Rutgers, Robert Wood Johnson Medical School, †Division of Pediatric Emergency Medicine, UMDNJ/Robert Wood Johnson Medical School; ‡Bristol-Myers Squibb Children’s Hospital, One Robert Wood Johnson Place, New Brunswick, NJ. Author Camacho was a medical student at the Rutgers, Robert Wood Johnson Medical School. Disclosure: The authors declare no conflict of interest. Reprints: Ernest G. Leva, MD, FAAP, Bristol-Myers Squibb Children’s Hospital, One Robert Wood Johnson Place, PO Box 19, New Brunswick, NJ 08903 (e
A Rare Presentation of Seizures in a Not-So-Rare Disease Henoch-Scho¨nlein Purpura Presenting With Repeated Seizures Christina Camacho, MD* and Ernest G. Leva, MD, FAAPÞþ
Abstract: Henoch-Scho¨nlein purpura represents the most common form of systemic vasculitis in children. Although a very common cause of vasculitis, seizures are a very rare complication of this disorder. We report a 5-year-old boy who presents with no other clinical symptoms of the disorder other than a seizure. By presenting this case, we hope to expand the differential diagnosis of repeated seizures to include diseases in which the pathogenesis of diseases with small vessel vasculitis such as Henoch-Scho¨nlein purpura is considered. Key Words: seizure, Henoch-Scho¨nlein purpura, small vessel vasculitis (Pediatr Emer Care 2014;30: 424Y426)
CASE A 5-year-old boy with no significant past medical history presented to an outside emergency department (ED) with a 1-week history of persistent nonbilious, nonbloody emesis, decreased appetite, and worsening abdominal pain. He had been on a recent trip to India that ended 1 month before his ED presentation. An investigation in the ED was undertaken consisting of abdominal computed tomography (CT) scan with and without contrast, complete blood cell count, complete metabolic panel, and urine analysis. Laboratory studies disclosed the following values: white blood cell count, 13.3; hemoglobin, 14 g/dL; hematocrit, 40%; platelet count, 377,000; 61% neutrophils; 21% lymphocytes; and 12% monocytes. Complete metabolic panel disclosed the following values: sodium, 129 mEq/L; potassium, 4.3 mEq/L; chloride, 92 mEq/L; and bicarbonate, 26 mEq/L. Abdominal CT scan visualized a normal appendix with no other pathology; however, a large amount of stool throughout the colon was found. He was subsequently discharged home with dietary advice and the recommendation to take MiraLAX with a diagnosis of constipation. The following day, while sitting on a toilet, he became unresponsive and was noted to have stiffening of all his extremities and both of his eyes deviating to the right. This activity reportedly lasted approximately 10 minutes. This episode was noted to resolve spontaneously, but because of increased confusion and sleepiness, he was taken by the emergency medical services to a local hospital for evaluation. On admission to the ED, he was noted to have a temperature of 97.4 F/36.3-C, blood pressure of 143/96 mm Hg, heart rate of 94, and an oxygen saturation of 99% on room air. Physical examination revealed dry mucous From the *Rutgers, Robert Wood Johnson Medical School, †Division of Pediatric Emergency Medicine, UMDNJ/Robert Wood Johnson Medical School; ‡Bristol-Myers Squibb Children’s Hospital, One Robert Wood Johnson Place, New Brunswick, NJ. Author Camacho was a medical student at the Rutgers, Robert Wood Johnson Medical School. Disclosure: The authors declare no conflict of interest. Reprints: Ernest G. Leva, MD, FAAP, Bristol-Myers Squibb Children’s Hospital, One Robert Wood Johnson Place, PO Box 19, New Brunswick, NJ 08903 (e
