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PURPURA (HSP)
(Renata,2012)
MANIFESTATION
(1/2 - 2/3 cases) ISPA 1-3 weeks earlier.
Arthralgia and arthritis (68-75% of cases).
Skin disorders are found in (95-100% of cases) in the form of macular
rash, petechiae and eczema, can be accompanied by itching,
symmetry, especially in the skin that is often exposed to pressure that
is the back of the legs, buttocks and sides of the ulna.
Macular rash color change:
abdominal dissorder (35-85% of cases) 1-4 weeks after onset.
Abdominal colic in periumbilikal, accompanied by nausea and vomiting.
Bloody diarrhea may accompany pruritic rash.
MANIFESTATION
(20-50% of cases) facial angioedema (eyelids, lips) and
extremities (back of hands and feet).
Kidney disorders are found in 50% of cases high in children and
25% are found in children <2 years of age. <1% progresses to
renal failure.
The risk of nephritis increases at the age of onset above 7
years, persistent purpura lesions, severe abdominal complaints
and decreased factor XIII.
Scrotum abnormalities resemble testicular torsion; Scrotum
edema may occur early in the disease (2-35%).
DIAGNOSIS
deposit of
IgA and
complement
on the wall
blood vessel
DIAGNOSIS
A. Kriteria American College of Rheumatology1990:
Bila memenuhi minimal 2 dari 4 gejala, yaitu:
1. Palpable purpura non trombositopenia 2. Onset gejala pertama < 20 tahun
3. Bowel angina 4. Pada biopsi ditemukan granulosit pada
dinding arteriol atau venula
B. Kriteria European League Against Rheumatism(EULAR) 2006 dan
Pediatric Rheumatology Society (PreS) 2006
1. Palpable purpura harus ada
2. Diikuti minimal satu gejala berikut: nyeri perut difus, deposisi IgA yang predominan
(pada biopsi kulit), artritis akut dan kelainan ginjal (hematuria dan atau
proteinuria)
Kriteria Definisi
Purpura non trombositopenia (palpable Lesi kulit hemoragik yang dapat diraba, terdapat
purpura) elevasi kulit, tidak berhubungan dengan
trombositopenia
for severe acute HSP phases; oral prednisone 100-200 mg daily and
cyclophosphamide 100-200 mg / day for 30-75 days before
cyclophosphamide is stopped directly and tapering off steroids up to 6
months. Patients with severe stomach pain, gastrointestinal bleeding or
decreased renal function, require hospitalization
Prognosis
Ad Bonam generally
Ad malam : if there are complications of kidney failure
REFERENCE
Yuly, A. Purpura Henoch-Schönlein. Dalam Cermin Dunia Kedokteran Edisi 194 Volume 139
Nomor 6. 2012. Available at http://www.kalbe.co.id diakses tanggal 14 July 2014
Matondang CS, Roma J. Purpura Henoch-Schonlein. Dalam: Akip AAP, Munazir Z, Kurniati N,
penyunting. Buku Ajar Alergi-Imunologi Anak. Edisi ke-2. Jakarta: Ikatan Dokter Anak Indonesia,
2007;373-7.
Bossart P. Henoch-Schönlein Purpura. eMedicine, 2005. Diakses dari
www.emdecine.com/emerg/topic845.htm Diakses tanggal 14 July 2014
Scheinfeld NS. Henoch-Schönlein Purpura. eMedicine, 2008. Diakses dari
www.emedicine.medscape.com/article/984105-overview Diakses tanggal 14 July 2014
D’Alessandro DM. Is It Really Henoch-Schönlein Purpura. Pediatric Education, 2009. Diakses dari
http://www.pediatriceducation.org/2009/02/ Diakses tanggal 14 July 2014
Kraft DM, McKee D, Scott C. Henoch-Schönlein Purpura: A Review. American Family Physician,
1998. Diakses dari http://www.aafp.org/afp/980800ap/kraft.html Diakses tanggal 14 July 2014