Introduction
A 5-year-old male patient presents to the pediatric office in March 2014 with complaints of a rash involving bilateral lower extremities and buttocks. The patient’s mother also explains to you that the patient has been complaining of pain in the bilateral knee joints during gym class. You notice a diffuse purpuric rash as well as swelling of the bilateral knee joints. The patient has also been complaining of diffuse abdominal pain that is cramping in nature and recalls symptoms beginning after recovering from a URI approximately 2 weeks ago. Otherwise physical exam is benign. Laboratory findings reveal a normal platelet count ::”:{:”:{:”:{:”;
This is a classic case of Henoch Schonlein purpura, one of the more frequent of the vasculitic conditions often affecting children [5]. Typically, cases are reported between the ages of 2 and 10 years of age [1]. Its effects are noted most commonly in the skin, joints, GI tract and kidneys due to IgA and immune complex deposits in capillaries [5]. The exact etiology, however, is largely unknown [1].
There are unique features to Henoch Schonlein purpura making the diagnosis largely clinical. The patient in the case above displayed all of the typical triad of features including palpable purpura, arthritis and abdominal discomfort [3]. An important feature of this type of purpura is the lack of thrombocytopenia on CBC [4]. In most cases, this condition is referred to as self-limiting but long-term consequences are largely due to the level of renal involvement [4].
Presentation of Disease
The case above provides a very classic case of Henoch Schonlein purpura. What information in the case should lead you to this diagnosis? As exhibited in the case above, upon acquiring a thoro...
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...ression between adults and children. Adults present more commonly with upper extremity rash, diarrhea, nephritic syndrome and renal insufficiency with labs showing elevated CRP, anemia and elevated IgA [2]. In comparison to children who show evidence of renal failure in 2-15% of cases, adults reveal a much greater incidence of 8-68% [2]. It is important to be aware of the poor prognostic indicators including “patients over age 20, high blood pressure, severe abdominal pain, hematuria, proteinuria, nephritic syndrome and anemia” [2]. Patients, especially those in the older age categories, should be closely monitored via close follow-up and urinalysis for progression to renal insufficiency and renal failure once the diagnosis of HSP is suspected.
-poor px = expression of renal alpha smooth muscle actin 4
-high range proteinuria and nephritis = poor px factors 5
Arch Dermatol. 2007;143(1):124–125. Puchenkova, S. G. (1996). "
National Institute of Arthritis and Musculoskeletal and Skin Diseases. "Hidradenitis Suppurativa: MedlinePlus." Nlm.nih.gov/. U.S. National Library of Medicine, n.d. Web. .
Some cases are severe and patients can develop hemolytic uremic syndrome, or HUS, which is a type of kidney failure. There have been no cases of HUS or deaths from this outbreak.
that cause dark red blotches on the skin, usually on the face). Laboratory tests are another consideration of diagnosis. Tests consist of anti-nuclear anti-body (ANA) counts and anti-topoisomerase (an enzyme that reduces super-coiling in DNA by breaking and rejoining one or both strands of DNA). High ANA’s and low anti-topoisomerases are found in patients with Raynaud syndrome. (Desai, 2003) “Patients with circulating autoantibodies, antinuclear antibodies, and anti-Scl 70 antibodies are at (an) increased risk of developing a connective tissue disease. Systemic sclerosis is the connective tissue disease most frequently associated with Raynaud’s phenomenon.” (Bowling, 2003) This syndrome is described as primary Raynaud phenomenon (PRP) if is not associated with another disorder and as secondary Raynaud phenomenon (SRP) if it occurs in association with another disorder.
P3 – Describe the investigations that are carried out to enable the diagnosis of these physiological disorders
•The forty five year old patient is diagnosed with the progressive cirrhosis inflaming the liver along with the parenchymal cells. The plain symptoms is manifested primarily because of the augmentation of edema internally in the lower abdomen.
HZ patients typically present with a characteristic, distinguishing unilateral, localized, vesicular eruption in dermatome distribution, that is often followed by an intensive localized prodromal pain. In rare instances, it is acco...
Gamma-hydroxybutyrate (GHB) is a depressant that affects the central nervous system. It was first created in the 1920’s and was under development as an anesthetic agent in the 1960’s. GHB is produced naturally in the human body in very small amounts, but its purpose or function is unclear. The drug came on the scene recently as a club drug at all-night dance parties and raves. GHB causes both an intense, euphoric high and sometimes it even causes hallucinations. GHB has caused many young people to require emergency medical care. Because the liquid is odorless and colorless, GHB diluted in drinks is virtually undetectable and sometimes is slipped unknowingly into someone else's drinks. This is why the drug got the nickname of the “date rape drug” because would-be rapists would slip the drug into an unsuspecting victim’s glass and then take advantage of their compromised state.
J.P. was positive for dyspnea and a productive cough. She also was positive for dysuria and hematuria, but negative for flank pain. After close examination of her integumentary and musculoskeletal system, the examiner discovered a shiny firm shin on the right lower extremity with +2 edema complemented by severe pain. A set of baseline vitals were also performed, revealing a blood pressure of 124/80, pulse of 87 beats per minute, oxygen saturation of 99%, temperature of 97.3 degrees Fahrenheit, and respiration of 12 breaths per minute. The blood and metabolic panel exposed to several abnormal labs.
The theoretical part describes the newest findings of the pathogenesis, overview over the typical clinical picture, most common diagnostic methods, especially OCB investigation, and clasical and modern threatments of the disease.
United States Renal Data System (USRDS). (2008). Annual data report: Incidence and prevalence. Retrieved July 8, 2009, from http://www.usrds.org/2008/pdf/V2-02-2008.pdf
The patient is a 30 year old male with an active bacterial infection on his right leg attacking his Integumentary system. The patient is from Tanzania, Africa but came back to work in a factory that produces plastic. If he has Cellulitis, it can get bad enough to travel to other organs like the Liver and Kidney and cause failure. If this happens, Edema can form, usually on one half of the body; this is the Urinary system being attacked. The main system being attacked is the Lymphatic system because Cellulitis attacks the lymphatic draining system. For Cellulitis to travel to organs, it had to go through the blood, so the cardiovascular system is also in effect.
From the results of the numerous tests carried out according to the patient history of frothy urine with a significant oedema over a maximum period of 5 days, the patient was diagnosed with Nephrotic Syndrome. This is condition that occurs due to leakage in the kidney filtration part leading to a large amount of protein leaking from the blood into the urine. This is mainly due to fluid retention known as oedema which is as a result of low protein level in the blood. It occurs due to abnormal functioning or a part of the kidney is affected (glomeruli). This syndrome can be caused by numerous diseases coming together to cause or form one particular disease; these causes range from minimal change disease, membranous nephropathy, focal segmental glomerulosclerosis (FSGS) and other conditions, disorders of the glomeruli. The membranous nephropathy also known as the membranous nephritis or membranous glomerulonephritis, only causes diseases in adults and very uncommon in children. Leakage occurs from this due to the thickening of the membranous in the glomeruli which is the filter of the glomeruli. Focal segmental glomerulosclerosis is a causative due to the formation of small scars (sclerosis) on some of the kidney glomeruli. Another form of cause of nephrotic is minimal change which is due to lack of virtual change detected in the glomeruli when examined under the microscope. This causes the syndrome in 9 out of a total of 10 children under the age of 5 years.
MEDICAL DIAGNOSIS: Empyema, Hemoptysis, Necrotizing pneumonia, Aspergillosis (Aspergillus fumigatus) cachexia secondary to malnutrition/infection, hypothyroidism, Diabetes Type II melitius , and...
The patient has also been suffering from frequent fevers in the past two months. He has also suffered from frequent headaches but has always taken painkillers (Bloland & Williams, 2003, p. 58). On fevers, the patient has frequently visited a local health clinic that has never done any diagnosis but has given medication, which reduces the fever.