Henoch-Schönlein purpura in the setting of COVID-19 infection: Two pediatrics cases and review of the literature

Abstract

Henoch-Schönlein purpura (HSP) is the most common systemic vasculitis in children, often following a viral infection. Various types of rashes attributed to COVID-19 infection have been described in the literature; however, HSP has rarely been reported. We report two children with HSP associated with acute COVID-19 infection with a review of the available literature. We highlight the clinical presentation, medical management, outcome and age-related difference of reported patients. A limitation of this article is the retrospective nature, limiting full patient history and associated conditions. The findings of this review show that HSP in the setting of COVID-19 is more common in children than adults, with a male predominance, involving various body systems creating a constellation of presentations. Given that HSP can have long-term morbidity from renal disease if untreated, this review may help guide the practitioner's approach to HSP and recognition in the setting of COVID-19 infection.

Keywords: Case report; Henoch–Schönlein purpura; coronavirus disease 2019.

Figure 1

Palpable purpura on the lower extremities

Figure 2

Palpable purpura on the lower portion of the legs and feet (a) and elbow (b)

Figure 3

Kidney biopsy showing glomerulus with fibrinoid necrosis of the capillary tuft taken at ×200 magnification (a), glomerulus with very focal endocapillary hypercellularity taken at ×400 magnification (b), and positive IgA immunofluorescence noticed for IgA complex deposition taken at ×200 magnification (c)