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Case Reports in Pediatrics
Volume 2017 (2017), Article ID 5483543, 6 pages
https://doi.org/10.1155/2017/5483543
Case Report

Central Nervous System Involvement in Henoch-Schonlein Purpura in Children and Adolescents

1Department of Pediatrics and Medical Genetics, Medical University-Plovdiv, Plovdiv, Bulgaria
2Department of Pediatric Surgery, “St. George” University Hospital, Plovdiv, Bulgaria
3Department of Imaging Diagnosis, “St. George” University Hospital, Medical University-Plovdiv, Plovdiv, Bulgaria

Correspondence should be addressed to Iliyana H. Pacheva

Received 8 July 2016; Revised 5 November 2016; Accepted 21 December 2016; Published 21 February 2017

Academic Editor: Abraham Gedalia

Copyright © 2017 Iliyana H. Pacheva et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Central nervous system (CNS) involvement in Henoch-Schonlein purpura (HSP) is rare but poses diagnostic difficulties. The aim of the study was to establish the frequency of CNS involvement in HSP, to analyze its clinical characteristics and do a literature review. Medical files of patients with HSP admitted at the Department of Pediatrics, Plovdiv, were studied retrospectively for a five-year period (2009–2013). Diagnosis was based on the American College of Rheumatology criteria. Out of 112 children with HSP 1 case (0.9%) had CNS involvement presenting as Posterior Reversible Encephalopathy Syndrome (PRES), which may be a result of CNS vasculitis or arterial hypertension. It was an 8-year-old girl with atypical HSP which started with abdominal pain requiring surgery. On the third day after the operation a transient macular rash and arterial hypertension appeared, followed by visual disturbances, hemiconvulsive epileptic seizures, postictal hemiparesis, and confusion. Head CT showed occipital hypodense lesions and MRT-T2 hyperintense lesion in the left occipital lobe. The patient experienced a second similar episode after 2 weeks when palpable purpura had also appeared. Neurological symptoms and MRI resolved completely. HSP can be an etiological factor for PRES in childhood. Although PRES is a rare complication of HSP, clinicians must be aware of it and avoid diagnostic and therapeutic delays.