Background: Henoch Schonlein purpura (HSP) is the most common vasculitis of childhood, characterized by leukocytoclastic vasculitis and IgA deposition in small vessels. Diagnosis is based on typical manifestations and the characteristic palpable purpuric rash.
Methods & Results: We report 4 patients who initially presented with HSP like palpable purpuric rash, but subsequently were diagnosed differently:
All patients had leukocytoclastic vasculitis on skin biopsy, but none had IgA deposition on immunofluorescence.
Conclusions: Although very common, not every case of palpable purpuric rash is HSP. A high index of suspicion is needed in prolonged and atypical cases. Immunofluorescence in addition to histology is important for the final diagnosis.
