LLQ Pain with a Twist

A young 24 year old gentleman with history of GERD on omeprazole presented with worsening LLQ pain for the past month. Described as “deep and aching”,  it was non-radiating and exacerbated with meals.  Additionally, he had associated nausea and non-bloody emesis with resolved non-bloody loose stools over the past week prior to admission.  He denies fevers, chills or night sweats, but does admits to 15-20 lb unintentional weight loss during this time period.  The twist of the case refers to the resolving non-pruritic, palpable purpura seen more so on the posterior thighs and buttocks, as well as on the extensor surfaces of the elbows bilaterally. Skin biopsy ensued.

Highlights of the discussion included the following:

1) Challenge of assessing symptoms independently (the abdominal pain and the rash) versus grouping them into one syndrome (instead , the rash as an extra-intestinal manifestation)

2)  Exploration of working diagnosis of Henoch-Schonlein Purpura (HSP) and the tools needed for diagnosis, including target populations and revised guidelines

3)  Specific gastrointestinal manifestations in patients who have the diagnosis of HSP, such as bowel wall thickening on imaging and complications such as intussusception.

Curious to learn more? Take a look at the following articles (here and here).