Conference moira::parenting

    
    Bob,
    
    I'm sorry to hear about Anna .. but this is really scarey for me to
    read.  Chris (well, everyone) recently had the same virus that you
    describe.  He then also had a strange rash, all over his torso, and was
    complaining about joint-aches.
    
    Chris complains if a hair falls out of his head, so I didn't put too
    much emphasis on what he was saying (ok, I told him it was part of the
    cold, and he'd be fine).  The nurse looked at the rash, said it was
    nothing, just the virus, and I spoke to the Dr over the phone, and she
    said the same thing.
    
    Now I'm wondering .... there's nothing in my (albeit lame) medical book
    about this condition, unless it goes by another name ...
    
    
    

    Entering henoch schonlein in the Alta Vista web index
    (http://www.altavista.digital.com) reveals several
    entries on the web. As always, this is to inform you only, not to be
    taken as medical advice.
    
    I scanned through
    http://www.mc.vanderbilt.edu/peds/pidl/nephro/henoch.html; my knowledge
    of medical terms is only marginally better than the average layman's
    since my wife is a nurse, but it seemed to be consistent with the
    basenote description. 
    
    http://www.wp.com/pedsrheum/prep1.html says: 
    
    "Henoch Schoenlein purpura (HSP):
    
    The characteristic presentation of abdominal pain, a vasculitic rash
    over the extensor surfaces of the lower extremities and buttocks,
    and arthritis is easily recongized in this condition. Because HSP is
    most often benign physicians may forget to evaluate for the presence
    of renal involvement. Unfortunately renal involvement may be present in
    one third of cases and in a small percentage of cases will
    proceed to renal failure. All children with HSP should be investigated
    for the presence of renal involvement with a proper routine and
    microscopic urine analysis as well as measurement of the blood urea
    nitrogen (BUN) and creatinine. If any abnormalities are present
    this should be followed by collection of a twenty-four hour urine for
    protein, creatine, and creatinine clearance."
    
    There are other references as well. Perhaps you can find out what "most
    often benign" means.

<<< Note 1068.2 by NETCAD::BRANAM "Steve, Hub Products Engineering, LKG2-2, DTN 226-6043" >>>
>    Entering henoch schonlein in the Alta Vista web index
>    (http://www.altavista.digital.com) reveals several
>    entries on the web. As always, this is to inform you only, not to be
>    taken as medical advice.

thanks....at the ER they did check 'kidneys', I assume this is
'renal involvement'.  they did a urine analysis as apparently
this condition starts to attack the kidneys after it gets the
muscles.

    
    	hmmm.  Is this mostly a pediatric ailment ?
    
    	I ask because last week, I noticed a strange rash on my
    	thighs in the evening, with a mild heat to the rash.  It was
    	gone the next morning, but yesterday, I had quite a bit of
    	abdominal pain, and tenderness in my right side.  All symptoms
    	are gone today, but this note just peaked my curiousity.
    
    

<      <<< Note 1068.4 by CNTROL::JENNISON "A turkey and some mistletoe" >>>
<    
<    	hmmm.  Is this mostly a pediatric ailment ?
    
    I'll write a little from some of the xerox's I have from Medical
    Journals....for me they are not much help.

"Henoch-Schonlein Purpura is a representative vasculitis of small arteries,
also known as hypersensitivity vasculitis or leukocytoclastic vasculitis.  It
is most common in children ages 4 to 11 and often occurs in the sping after a
bacterial or viral infection.

Polymorphonuclear leukocytes infiltrate the arterial wall and perivascular area.
Many of the leukocytes are destroyed and their nuclei fragmented.  Necrosis
occurs in the arterial wall, and extravasation of red blood cells gives rise to
the 'palpable purpura' skin lesion.  Renal, gastrointestinal, and cutaneous
vessels are most frequently involved.

Palpable purpura, arthritis, and abdominal pain constitute the classic clinical
triad.  Skin lesions are most common in the dependent (meaning lower) body
areas.  Evanescent arthritis and arthralgias occur in the ankles and knees."

That's from an emergency medicine manual....the most readable.

Another says that it mostly occurs in children but can occur at any age.

It will resolve and recur several times over a period of weeks or months.
It can be caused by immunization, as well as drugs, certain foods and insect
bites.

Most patients have the marked 'palpable purpura'..this means a raised
welt, quite red, not just a little rash.  In Anna these looked like LARGE
measle bumps, quite raised up.  Felt like running your hand over a large
relief map of the rockies.  Gastrointestinal involvement, which is seen in
almost 70% of pediatric patients, in characterized by colicky abdominal pain
usually associated with nausea, vomiting, diarrhea, or constipation, which is
frequently accompanied by the passage of blood and mucus per rectum; bowel
intrussusception may occur rarely.

Some journals said that kids become 'hypersentive' to asprin, so we
have discontinued the aspirin (although our doc recommended it).

Here is one great sentence....for example...

"Characteristically, immunofluorescence studies reveal mesangial and peripheral
capillary granular deposits of IgA, IgG, C3, and fibrinogen but not Clq, C4,
or IgA secretory piece."

That clears it up for me!
bob

    
    	Thanks, Bob!
    
    	The symptoms sound very similar, but are most likely not
    	related to this illness.  The rash I had was not like you
    	describe.
    
    

>      <<< Note 1068.6 by CNTROL::JENNISON "A turkey and some mistletoe" >>>
    
>    	The symptoms sound very similar, but are most likely not
>    	related to this illness.  The rash I had was not like you
>    	describe.

the specialist at Western Mass Kidney center said Anna's condition
is most likely Henoch-Schonlein, but...also might be
the beginnings of endocarditus.  She does have a marked heart murmur,
a sticky valve, since birth..

so we're back off to the ER for more tests for that!
small chance, but very possible.
bob    

    
    Bob,
    
    How is Anna doing?  I hope all is well.
    
    Please keep us posted.
    
    Cheers,
    Chris

>                     <<< Note 1068.8 by DSSDEV::PELLAND >>>
>                                -< Any update? >-

    We are still going on the diagnosis of Henoch Schonlein.
    She has had another milder 'attack', again covered with
    the purpura (welts), swelling of her ankles, and arthritic
    type pain in her ankles.  But the next morning she was
    bouncing around just like normal.  Went skiing today at
    a neighborhood slope.

    the comforting thing we were told is that since she had
    no kidney damage in the first attack, she is VERY unlikely
    to have any.  The first is the worse.

    Thanks!!! for asking.  It was VERY scary at first but now
    we just wait for the next one.  They said they may come for
    up to 4 months.
    bob