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  Hi, I hope you can help.My son had HSP one year ago.He had been on an
  antibiotic for tonsolitis, and then it was changed within a week,as he
  got an ear infection on top of it.That night his legs had hives with
  spots on them, and then they turned into purple bruises.He also had leg
  swelling.He was put in the hospital on an antibiotic drip, to help him
  fight the infections, and thus let his body deal with the HSP.
  His penis swelled a few days later, and after that he had such bad
  joint pain that he couldnt even roll over in bed, or be carried.
  Everything hurt. Every knee, ankel, hand and joint was swollen. Luckly
  that didnt last for too long, but for the duration of the HSP he
  moved very slowly, and could hardly get dressed.
  He had regular BP and urine tests.His BP was abit higher then usual,
  but still in the normal ranges.He occassionally had protien in his
  urine, but never blood.His legs and buttocks were 90% bruises.He did
  develop spots on his arms that itched.He did have tummy aches, but
  never so severe that he needed to be on steroids.He has always had a
  high threashold of pain.After a few weeks EVERY single spot turned
  into a huge buldging blood blister.This lasted for weeks, and then
  they started to open, so he was put on antibiotics,as with so many
  open wounds,infection was a concern.His worst part was the joint pain
  (which was helped a bit with drugs). My worst nightmare was just
  looking at him. I cried everytime.It was awful.Something you would
  think you would see in a third world country.It took at least 6 months
  before he was his normal active self again.Thomas is now 6. Its been
  a year. My concern is that Thomas gets very bad tummy cramps, they
  only last one hour.The doctor said all kids do, and its like an adults
  headache..due to stress or anything.Should I have Thomas followed up
  for his HSP?Should I have tests done on his kidneys or stomache? or
  once its over its over? I have not heard of anyone else getting blood
  blisters.This was my GP's only case.Is there a chance he will have
  problems later..especially kidney problems?Thank you for putting my
  fears to rest. I find it hard getting answers, especially since it
  seems Thomas had a more intense case. Thanks. jill  

Dear Jill:
Henoch-Schoenlein Syndrome (HSS) is a disease of small blood vessels whose cause remains unknown. Fortunately, your son appears to have recovered well, despite his frightening and prolonged illness.
Recurrences of HSS are common. Half of the patients have one or more subsequent bouts. They are not likely to be as severe as the original episode. Most occur within the first year after the original illness.
Kidney involvement is common, and often more severe in older children and adolescents. However, if microscopic hematuria (red blood cells in the urine seen only under magnification) is the exclusive manifestation of kidney disease, no long-term damage is likely. You stated in your note that protein but no blood was found when the disease first presented. It is important to be clear about how much protein was present, since small amounts may be unrelated to kidney disease. Your son's doctor should be able to tell you if there were any other signs of kidney disease at the time. If there were, long-term follow-up is necessary to assure that renal impairment does not develop over time. However, if no conclusive evidence of kidney involvement was present, the outlook is exceedingly bright and follow-up can be much more limited.
Abdominal pain associated with HSS may occasionally be associated with significant intestinal bleeding or an obstruction. Such problems are likely to occur with the initial episode. This was fortunately not the case with your son. Recurrent pain could represent the reappearance of HSS but only for one or two episodes. You imply that Thomas has had several bouts of crampy abdominal pain without other symptoms. If so, you should look for an explanation other than HSS. Non-specific abdominal pain is indeed quite common in children. About one in ten have pain which recurs over a period of three months or more. Constipation is a common explanation. Is this a possibility? Most serious causes present with fever, diarrhea, vomiting, loss of appetite, and weight loss. I presume none of these are present.    
I hope this information proves helpful. It is presented for educational purposes only. May you and your son do well.
KEYWORDS: Henoch-Schoenlein Purpura

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