Publication:

Atypical presentation of Henoch–Schönlein purpura in a paediatric patient initially presenting as gastroenteritis and lymphadenopathy

Henoch–Schönlein purpura (HSP) is the most common small-vessel vasculitis in children and is classically characterized by palpable purpura, arthritis, and gastrointestinal involvement. However, atypical or temporally delayed presentations may lead to diagnostic uncertainty. We report the case of a 6-year-old girl who initially presented with epigastric pain, high-grade fever, and abdominal lymphadenopathy suggestive of gastroenteritis. After initial improvement and discharge, she re-presented with knee arthritis, persistent fever, and subsequently developed palpable purpura. Septic arthritis was excluded, and skin biopsy findings were consistent with vasculitis, confirming the diagnosis of HSP. Treatment with corticosteroids led to rapid clinical improvement. This case highlights the importance of reassessment and clinical vigilance in children with evolving multi system symptoms.