Allergic Purpura Syndrome
Said Schonlein-Henoch purpura, hemorrhagic capillaries of poisoning (Hemorrhagic Capillary Toxicosis), is due to abnormal capillary caused by systemic hemorrhagic disease, can affect the skin, joints, kidneys and gastrointestinal tract in the corresponding symptoms. This disease more common in children and adolescents.
[Diagnosis]
According to the upper respiratory tract infection, a skin purpura, and joints, stomach and kidney involvement at the same time the performance of a recurrent feature, should consider the possibility of this disease. It should be noted and ITP, acute abdomen, glomerulonephritis, rheumatoid arthritis for identification.
[Treatment]
1. Removal causes include: anti-infection, remove Gan Ranzao to remove intestinal parasites, to avoid application of the food and drug allergies. 2. Anti-histamine drugs: choice of chlorpheniramine, promethazine, diphenhydramine, such as drug Astemizole oral or intramuscular injection. Applications can also be 10 per cent of calcium gluconate 10 ml intravenous injection, 1 to 2 times daily.
3. Glucocorticoid: the acute phase and applied to the abdomen, joint pain obviously, can quickly ease the symptoms. Prednisone can be given orally, if necessary, hydrocortisone infusion. Short-term medication (3-5) can ease the withdrawal symptoms, but to use a longer time after the withdrawal should be gradual reduction.
4. Other: the acute phase should be bed rest, gastrointestinal symptoms should be fasting. High-dose intravenous vitamin C (3 ~ 5g / day). Abdominal pain can be intense intramuscular injection of atropine 0.5 ~ 1 mg. Bleeding tendencies may choose to stop bleeding drugs. Have kidney damage.
[ET]
The disease of unknown, and a variety of factors may be relevant, ① infection, the disease often in patients with acute infection, the incubation period and after a certain morbidity, and more acute upper respiratory tract infection, hemolytic streptococcus pathogens to mainly, but also for the Staphylococcus aureus, viruses, parasites and infections, ② food allergy, such as fish, shrimp, crab, milk protein allergy, and other allograft, can be induced by the disease, ③ drugs, such as the Green streptomycin, sulfonamides, salicylic acid , And other preparations. It is also possible with the cold, insect bites, pollen dust and other factors related to contacts. All these factors on the body as small arteries, veins and capillaries on the wall of inflammatory changes in vascular permeability-increasing, from subcutaneous tissue, mucous membrane and vascular organ of the exudative hemorrhage edema, and a corresponding clinical manifestations.
[Pathological changes:
Blood and skin around the lymphocytes and plasma cell infiltration, the dermis layer of capillary was inflammatory changes, leakage, swelling, bleeding, caused by skin purpura. Edema of the intestinal mucosa, leakage, bleeding caused by abdominal pain, and so is the reason. And joint pain around joints mainly due to edema, joint cavity caused by leakage. Kidney involvement that glomerular cell proliferation, stoves necrosis, capillary thrombosis, but also the foreseeable edema tubular epithelial cells, degeneration, fibrosis.
[Clinical]
Before the onset 1 to 3 weeks often have the upper respiratory tract infection, the slow onset, duration protracted, often alternating attack and mitigation, according to the lesions of different positions, and have different clinical features:
1. Skin performance: most of the skin purpura as the first symptom. Often seen in the limbs remote stretch side, hip back, face and torso while rare, Purpura was symmetrical distribution, in batches, large and small, and integration into films, even hemorrhagic form of herpes and hemorrhagic necrosis. Purpura general a few days to be dissipated. At the same time be accompanied by a small number of eyelids, lips, hand, foot and part of vascular edema, or urticaria.
2. Gastrointestinal change: more skin purpura after abdominal symptoms, but also to gastrointestinal symptoms as the first persons. Mainly for the onset of Chang Jiaotong, and for continuing Duntong in Qizhou or lower abdomen, accompanied by nausea and vomiting, are re-emerging blood in the stool, hematemesis, intussusception and intestinal perforation. Investigations have tenderness in the abdomen, but no muscle tension and anti-Tiaotong. If abdominal symptoms as the main performance, as abdominal allergic purpura (Henoch Purpura).
3. Joint performance: performance for the swelling limbs joint pain, knee, ankle, elbow, wrist, etc. Most of regular migration, a few days dissipated, can be repeated attack, attack often accompanied by low heat. To joint symptoms for outstanding performance, known as joint-allergic purpura (Schonlein Purpura).
4. Kidney performance: changes in the kidney often purpura after the emergence of performance for proteinuria, hematuria, the management of urine, some patients may be accompanied by swelling, oliguria and hypertension. Under normal circumstances the disease better kidney damage restoration, leaving after-effects, to be a small number of chronic nephritis, even uremia. Should pay attention occasionally to kidney disease and the main performance was not obvious to Purpura.
In addition vascular leakage bleeding and edema can also affect the nervous system, such as respiratory and corresponding symptoms.
[Examinations]
Bleeding, clotting time, the platelet count and function normally, ESR can be normal or mildly by fast. Some patients with vascular brittle test (beam arm test) positive. Kidney involvement may have proteinuria, hematuria, the type of urine.
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