# IgA vasculitis (Henoch-Schonlein purpura) - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: IgA Vasculitis (Henoch-Schönlein Purpura) - StatPearls (NCBI Bookshelf NBK537252) - https://www.ncbi.nlm.nih.gov/books/NBK537252/ · IgA vasculitis (Henoch-Schonlein purpura) - disease-level clinical article (henoch-schonlein-purpura-full.txt) · IgA vasculitis (Henoch-Schonlein purpura) - disease-level clinical article (henoch-schonlein-purpura-clinical.txt) - Verified date: 2026-08 ## Verified against - IgA Vasculitis (Henoch-Schönlein Purpura) - StatPearls (NCBI Bookshelf NBK537252) - https://www.ncbi.nlm.nih.gov/books/NBK537252/ - IgA vasculitis (Henoch-Schonlein purpura) - disease-level clinical article (henoch-schonlein-purpura-full.txt) - IgA vasculitis (Henoch-Schonlein purpura) - disease-level clinical article (henoch-schonlein-purpura-clinical.txt) ## Treatment metadata - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text IGA VASCULITIS (HENOCH-SCHONLEIN PURPURA) Sources: IgA Vasculitis (Henoch-Schönlein Purpura) - StatPearls (NCBI Bookshelf NBK537252) - https://www.ncbi.nlm.nih.gov/books/NBK537252/ · IgA vasculitis (Henoch-Schonlein purpura) - disease-level clinical article (henoch-schonlein-purpura-full.txt) · IgA vasculitis (Henoch-Schonlein purpura) - disease-level clinical article (henoch-schonlein-purpura- clinical.txt) Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Tiredness, headache, fever, and joint pain can accompany the rash of IgA vasculitis [fatigue · fever · headache · joint pain · rash] - Gut symptoms in IgA vasculitis include diarrhoea, vomiting blood, belly pain, vomiting, and rectal bleeding [abdominal pain · diarrhoea · rectal bleeding · vomiting · vomiting blood] - Nausea and vomiting can worsen after meals in IgA vasculitis [nausea · vomiting] - A rare central nervous system form can bring headache, dizziness, unsteady gait, seizures, or irritability [dizziness · headache · irritability · seizures] SIGNS - what you find (11) - Skin involvement, usually the earliest sign, is present in every patient with IgA vasculitis - The rash starts as red, flat, or hive-like patches [rash] - The rash evolves into palpable purpura and pinpoint bleeding spots, mostly on the buttocks and the backs of the legs [bleeding · purpura · rash] - About a third of patients also get the rash on the arms and trunk [rash] - Blistering or dead-tissue skin lesions are linked to renal failure that resists treatment [skin lesions] - The rash changes colour from red to purple to rust over about 10 days before it fades [rash] - Swollen, painful joints most often affect the knees, ankles, hands, and feet - Joint involvement is typically short-lived and leaves no lasting joint damage - Subcutaneous swelling can occur in IgA vasculitis - Scrotal swelling can occur in IgA vasculitis [scrotal swelling] - Intussusception is the most common life-threatening gut complication, affecting 3 to 4% of patients TESTS (8) - Diagnosis needs petechiae without a low platelet count, or purpura mainly on the legs, plus at least one of four extra features - Urinalysis with microscopy checks for blood, protein, or red cell casts - A positive urine dipstick for protein prompts a 24-hour collection to quantify the loss - A positive urine protein test is seen as a warning sign that the disease may recur - Serum IgA is not diagnostic on its own, though a marked rise suggests the disease - Ultrasound is often the first imaging test, mainly to rule out hydronephrosis - Endoscopy can show purpura in the stomach, duodenum, and colon - A raised D-dimer accompanies intussusception in this condition IF NOT THIS - what else fits (10) - IgA vasculitis must be differentiated from IgA nephropathy - IgA vasculitis must be differentiated from immune thrombocytopenia - IgA vasculitis must be differentiated from disseminated intravascular coagulation - IgA vasculitis must be differentiated from thrombotic thrombocytopenic purpura - IgA vasculitis must be differentiated from haemolytic uraemic syndrome - IgA vasculitis must be differentiated from meningococcal meningitis - IgA vasculitis must be differentiated from systemic lupus erythematosus - IgA vasculitis must be differentiated from polyarteritis nodosa - IgA vasculitis must be differentiated from granulomatosis with polyangiitis - IgA vasculitis must be differentiated from Rocky Mountain spotted fever Source IgA vasculitis (Henoch-Schonlein purpura) - disease-level clinical article (henoch- schonlein-purpura-full.txt) Status traced to the source above 1. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source IgA Vasculitis (Henoch-Schönlein Purpura) - StatPearls (NCBI Bookshelf NBK537252) - https://www.ncbi.nlm.nih.gov/books/NBK537252/ Why IgA vasculitis usually settles on its own, and the two things that make it dangerous are an abdomen that turns surgical and a kidney that declares itself weeks later. Both are follow-up problems, which is why the urine matters more than any prescription. The article names paracetamol and prednisolone but states no amount for a child, so no dose is printed. Caution WHAT MAKES THE DIAGNOSIS - IgA vasculitis is diagnosed on petechiae with a normal platelet count, or on palpable purpura falling mainly over the legs, together with at least 1 of 4 further features: pain in the abdomen; joint pain or frank arthritis; the kidney involved, shown by protein in the urine, red cell casts or blood; or, on histology, a proliferative glomerulonephritis or a leukocytoclastic vasculitis in which IgA is the dominant deposit. WHERE THE RASH SITS - it turns into purpura you can feel and into petechiae, sitting most often over the buttocks and the legs, and on the extensor surfaces above all. Every patient with IgAV has skin involvement, and it is usually what shows first. TEST THE URINE, AND KEEP TESTING IT - order a urinalysis with microscopy, looking for blood, protein, or red cell casts. Where the dipstick shows protein, follow it with a 24-hour collection to measure how much is being lost. What matters over the long run, in the article's own summing up, is following the child properly and testing the urine often, so that the kidney is caught if it becomes involved. THE KIDNEY DECLARES ITSELF AFTER THE RASH HAS GONE - renal symptoms tend to arrive 1 to 3 months after the rash appears, and they do so in 20% to 55% of affected children. Where proteinuria persists, the risk of a progressive glomerulonephritis is high. A child discharged the week the rash fades has been discharged too early. AND THE KIDNEY IS WHAT KILLS - dying of IgA vasculitis is rare, but of everything that makes these patients ill or kills them, kidney disease is the commonest. RED FLAG - THE ABDOMEN. The complications that can end a life are intussusception, a perforated bowel, gangrenous bowel, and torrential bleeding. Of those, intussusception is the one seen most, in 3% to 4% of children with IgAV. Severe abdominal pain in a child with purpura is a same-day surgical assessment. THE ABDOMEN CAN COME FIRST AND FOOL EVERYONE - in 10% to 40% of patients, the gut trouble shows up ahead of the rash. PREFER PARACETAMOL OVER AN NSAID WHEN THE GUT OR KIDNEY IS INVOLVED - where the bowel or the kidney is involved, paracetamol, or an opioid, is generally chosen for pain ahead of a non-steroidal anti-inflammatory. The article states no strength, frequency or maximum for a child, so no amount is printed here. STEROIDS ARE A SPECIALIST DECISION, NOT A FIRST PRESCRIPTION - where the abdominal pain is severe, prednisone or prednisolone with a tapering course is worth considering. It will not stop renal disease from happening, but it does lower the chance that renal complications persist in a child. No paediatric dose appears in the article. MOST OF IT IS SUPPORTIVE - where the kidney is not involved, treating the symptoms and supporting the child is what the management rests on. WHAT TO TELL THE PARENTS - teach them that the symptoms will probably clear inside a few weeks, though they may come back. Full recovery takes 4 weeks in most children. About one in three has a recurrence, 4 to 6 months after it first began. JOINTS ACHE BUT DO NOT SCAR - 75% of these children get joint pain or arthritis, and it passes without destroying the joint. THE SMALL MINORITY THAT ENDS BADLY - roughly 1% of patients with IgA vasculitis go on to end-stage renal failure and need a transplant. A child with proteinuria belongs to a nephrologist: where the renal involvement is severe, treatment must be aggressive and the care must be a nephrologist's. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)