Henoch-Schnlein purpura with hemorrhagic bullae in children: report of two cases

Po-Mai Liu¹, Chin-Nam Bong², Hsin-Hsu Chen³, Yi-Chuan Huang³, Chao-Cheng Huang⁴,Kuender D. Yang³, Chih-Lu Wang^3
1Department of Pediatrics, E-Da Hospital, Kaohsiung; ²Department of Pediatrics, Pingtung Christian Hospital, Pingtung; and Departments of ³Pediatrics and 4Pathology, Chang Gung Childrens Hospital, Kaohsiung, Taiwan, ROC

Received: January 19, 2004 Revised: March 1, 2004 Accepted: June 6, 2004

Corresponding author: Dr. Chih-Lu Wang, Department of Pediatrics, Chang Gung Childrens Hospital, 123 Ta-Pei Road, Niaosung Hsiang, Kaohsiung, Taiwan 833, ROC. E-mail:

Henoch-Schnlein purpura (HSP) is the most common form of acute vasculitis primarily affecting children. Clinical features include skin rashes, arthritis, abdominal pain and nephritis. Skin biopsy on immunofluorescence often reveals granular depositions of immunoglobulin A (IgA) and C3 within the walls of the dermal vessels as well as in the connective tissue of the upper dermis. The diversity of skin rashes produces confusion in diagnosis of HSP, especially in the presence of bullous lesions. Bullous lesions are very rare in children with HSP, whereas they often appear in adults with HSP. We report 2 cases of HSP in whom hemorrhagic bullae manifested predominantly. In our report, the skin biopsies of both patients revealed typical leukocytoclastic vasculitis without IgA and complement depositions on direct immunofluorescence studies. Dramatic improvement of clinical symptoms and signs was observed within a few days after corticosteroids were administered. There was neither recurrence nor nephritis in these 2 patients.

Key words: Hemorrhagic bullae, Henoch-Schoenlein purpura, leukocytoclastic vasculitis, vesiculobullous skin diseases

J Microbiol Immunol Infect 2004;37:375-378.