ANAPHYLACTOID A

Long-term Follow-up

PURPURA (SCHbNLEIN-HENOCH SYNDROME)

Study with Special Reference

to Renal
By Ralph
NAIIIYLACTOID

Involvement
and The However,
vascular Marshall

J. P. Wedgwood,
purpura is a

M.D.,*

H. Klaus,
of
and

M.D.
is unknown. wide-spread
of the frequent

generalized a specific by joint exa eruplesion its is that around from name. of an the ac-

etiology
lesions,

the of

disease the

disease skin lesion, synl1)ton)S

iiianifestatioiis.

characterized usually and often The (Iescribe(l from or classic disease the skin red has accompanied by specific by urticaria,

by

because

because

gastrointestinal skin de lesion, consists through

occurrence with beta

been the suggested group a hypersensitivity

of preceding infection, hemolytic streptococci,

that of so-called the state disease and collagen belongs

it

often has
in

teiisivelv of tion
which

represents diseases.

)rogre55iOfl pink to the the

l)lanching

rnaculopapular purpuric derived lesion

exudate

The the acute

purpose phase

of this and of the

paper

is to determine of sequelae to the

frequency

nature disease.

Histologically
acute inflanirnatory

small tual prefers droiiie.

vessels heliiorrhage. the naiiies to classic iiianv

to

of term of the and have who

the For

corium this

rather reason

than Gairdner1

PATIENT
Between

MATERIAL
1953, were in 36 Twenty-six 1954 age months 2 and at to were of cent during were onset 123 children with to Babies children alive of years (Fig. and svmpand 1). 9 obyears admitted

1939

and Hospital.

Schonlein-Henoch Sch#{246}nlein disease complete

Syn-

anaphvlactoid and who Childrens could ranged was be

purpura located The 13 from between

The
attached early, its
SCCII15

afl(l l)ecause

Henoch
of The

are
their of disease

considered toms usually

well.

description 1)rSflttl extensively Certainly challenge on these lesions the only)

4 years

manifestations.2
IWCI1 1

Seventeen of the were female. This the anare 2: 1 is similar servers.1 to the Although to the

patients sex ratio ratio 20 hospital per

male and approximately

to thors l)tIt

Osler

wrote that

reported

by other
of the these patients

visceral

manifestations. recogiiized (although

manifestation As

the

skin

a minor

at times of

obdismaniit

z
LU -J
C-) Li

admitted

servable ease. festations seems into 2 of

a generalized and joint present, the

gastrointestinal are little svn(lrOITIeS 1)0th value frequently to merely

MALE 6 FEMALE

separate because of one

disease of the or

Precl011iifl11it another.
From

involvement

system

04
LU

the

1)epartments

ogv, and This

grant

\Vestcrn Childrens
Ohio.

of Pediatrics Reserve University, and hospital, University

and Patholthe Babies Hospitals, by research Institutes of

accepted

Cleveland,

z 024 1012 AGE IN YEARS

Fic,

health, April
O

work was in part supported 1l-1643 from the National U. S. Public Ilealth Service.
Aug.
1955.)

(Submitted
1:3,

26,

1954;

revision Road,

ADDRESS:

2065

Adclhcrt

Cleveland

6,

Ohio.

1. Age

at onset

of

symptoms.

196

ORIGINAL
were Negro,
no

ARTICLES
the allergenic described agents. As might the (Fig. ties of trunk. purpura, and small in the disease, 2). all arms The but red The be suspected all rash and skin also patients; of the involved half one-third lesions urticaria, pinpoint also had consisted erythema, macules or from children the had the definition had lower lesions not factors
iii

197 as the specific literature foods

#{176}

Negroes may on

were reflect the

found the negroid in the children racial immediate have

among difficulty skin attack were background.

have as

been

36

patients

with which purpura

anaphylactoid

purpura,

a disin rather rate. de-

causative of

crepancy recognizing

than an actual difference In all other respects the rived No of the from other children a widely members
in

purpura extremion only edema, papules. the of

varied of the the series

involvement

families been known or sympin these

to have had toms suggestive

anaphylactoid of it; nor

purpura was there,

0%
PURPURA ARTHRALGIA
ABDOMINAL PAIN

50%

100%

FEVER PROTEINURIA

VOMITING
MICROSCOPIC HEMATURIA BLOOD IN STOOL

10 NUMBER
* BENZIDINE TEST PERFORMED Fic. IN ONLY 2. Initial

15 OF CHILDREN
7 PATIENTS and signs.

20

25

symptoms

families,
cidence of

any
any

suggestion of

of

an

unusual

in-

the

so-called

collagen children infection with the throat beta with had prior onset

disa to of

Sixteen ing of ankles, some cause ment and toms and blood amined. melena.

of the one or or of wrists. limitation mild

twenty-six had moderate more joints, usually the Although of to was tenderness motion moderate not there of severe; were phase 1 1 had of emesis. were positive children referable abdominal Tests in for 3 of these the heat, usually had pain, was joints

swellknees, usually beinvolveredness absent. sympto the pain, occult 7 ex-

eases. Thirteen of the twenty-six history of upper or occasionally purpura.

were obtained,

respiratory concomitant 5 harbored is in In

generally exquisite of the the episodes the

Of 9 children This

in whom agreement

cultures hemolytic other

Twelve during 7 had in gastrointestinal

twenty-six acute tract,

streptococci. published find an a family allergic

4 by
gestive

reports. allergic diathesis history manifestations had allergy of had

a thorough search to in the children, 4 gave but were and eruptions, without another sugand

allergy minor

stool

themselves, (hives, drug

history
of

manifestations

Two of these children One of these (Case 19) intussusception bowel removed. an exploratory obstruction just

had gross was operated

I)0S5i11e asthma). Iii iione of the any specific allergen be implicated cipitating factor in the disease.

children could as the preHowever, such

upon for gangrenous 17) had intestinal

and a section of The other (Case for to the possible onset of 1)rior

laparotomy

198

WEDGWOOD

ANAPHYLACTOID

PURPURA

z8
LU
-J

z
LU
-J

I C)
.Li

I C)

0
LU

LU

#{174} 5 8
FIG. :3. WBC
ptlrp(lra.

II WBC

17

20 and

X 1000
acute phase.

over

#{174} o
Fic.
normal abnormal
4.

123456

I
and

MINUTES
Bleeding time Bleeding only 5 of the during times 21 acute (Fig. patients phase. 4) were tested. limits. in

(luring

bowel

At operation was seen.

hyperemic

and

edematous

At
hospital had
ill

the

time
9 of

of the
the (Cases

initial

admission
were febrile.

to the
Four

children

hypertension

1 child

(Case
and

19)
responded

was

8, 17, 19, associated to Physical

24), which with conwith infecwas was no examination,

Clot retraction was normal in 12 children examined and platelet counts were within normal limits in 18 children on whom this examination was performed. including alone Routine urinalyses re-

u1sions

treatment respiratory involvement,

vealed
in sion.

proteinuria
Proteinuria

microscopic
the was 4 with found in

hematuria
hyperten3 others.

magnesium apart tions, not more atric only was from skin common population. 2 children. found.

sulphate. evidence lesions, than No and

is

6 children,

of upper joint
seen in

remarkable.

Lymphadenopathv

the
was

general
palpable

pediin disease

The

spleen evidence

The duration of the initial symptoms ranged from 6 to 180 days (Fig. 5). Usually the initial manifestations of the disease subsided in 4 weeks. Those children in whom the illness
ran a protracted course generally had a severe

of heart

form children,
were and normal hematocrits. varied white on from counts infection. differential)

of
and

the

disease,
exacerbations. of the

characterized
During received some acetyl and children

by
the

remisacute salicylic

All
mildly amination

of the
anemic,

except
found

for
on blood The 5800 could was

3 who
laboratory cell white to not found

were
excounts, blood

sions phase for their

some

antibiotics

to have (Fig. Elevated per cent The was 3)

red

infections

hemoglobin, counts mm.. attributed to 10 patients. \Vintrobe) 12 children, and normal

22,000/ all in be (4 5 in in 4 chil-

acid for analgesia. given antihistamine

A few of the children were without proven effects;

to existing

Eosinophilia rate (corrected 15 mm./hr.) in 4 of 20

sedimentation elevated (above (10 10 mm. hr.)

w
0 -J4 C.)

borderline (below

to 15 mm.,/hr.)

dren on whom the examination Elevated sedimentation rates related tourniquet positive clotting with test in only the existence in were performed 3. Studies

was performed. were not corof 12

infection.

U
.

,
I

A
was and within
FIG.

0 I
5.

8-12

6 mos.

children bleeding

WEEKS1)uration of initial phase of the

I d
disease.

over

of the

mechanisms

generally

ORIGINAL
none hormone. was given cortisone or adrenocorticotropic

ARTICLES weight
ma!

199 of the children

by

fell
the

within
Harvard

the Blood

norpnes-

ranges

defined

School

M ETHODS
The
interviewed

of Public
be by the their taken located authors. with acute was preserved by a examined special disperwere At

Health were 21,

growth

curves. all but after the

were

26

children and a full on the

who examined history interval physical collection formalin,

could was

sures ( Cases fined

sures

normal in 24). However, in the The was On hospital remainder entirely

of 2 children

2 patients being conblood

within

this ease. formed. with the was

time

to bed
in these

presthe

emphasis

since

Complete A 12-hour thymol or

examination of urine, was

normal examination children.

was no

range.

of the normal examination

the retinal

physical in all
vessels.

the

funduscopic no
any

there heart
Although

Addis technic. measured with tube. were fasting. by subsequent of the for and Hospital During repeated carried

Urinary protein excretion Tsuchiyas reagent in Urea out on Addis examination child more urea to Babies complete Addis clearance tests and the were renal nitrogen blood counts, were and deterobtained if yencause Chilrenal counts and pencon-

abnormality

There
disease
several

was
in

evidence
of the

of
children.

organic

Shevky-Stafford minations (luring fled for drens

studies. were

Abnormal

grade heard, or respiration urea

1 soft these

basilar and were

systolic thus

murmurs with exerconsidered on 23 A

were cise

all diminished

admission

hospitalization multiple excretion pvelograms studies of

functional. Blood children ml. with

summary

nitrogen

determined

phenolsulfonphthalein formed.
centration

varied between a mean of of urinary

8, and 9. In these Ten over

9 and 18 mg./100 14 mg./100 ml. is shown

figures

Intravenous to and dilution determinations

findings

in Figduplicate

addition chemical of the

rest.

were done in usual blood was made while at

ures or
by

7,

multiple
a mean

determinations
value. well of the
12

are
the limit J

represented
children of had normal average

values. Careful observation blood pressure of the patients

hematuria

(600,000

rbc/12

8 the

RESULTS
In
years ease child

the
had and had than

Illajority

of

patients

2 or
the onset (Fig. years, been of 6).

more
disOne

2 or more Addis counts in excess of a million red

of

showed hematuria cells per 12 hours. excretion was cell red of 100,000 found. casts casts 23, excess 24) of
excretion particu-

elapsed the Only 1 year. 1 of the follow-up been

between studies 15 had followed

In 12 children or some dition seen. more to In average

hr. with
these

a urinary per children and 2 children proteinuria

observed. was regard to
was

casts hyaline only

12 hours granular (Cases in

The widely sex,

In in adwere was
100

another followed

of these

8 years.
less All
fronl

2 children

but
symptoms

children
of

had

been

free

an mg./12 of larly 1
of

suggestive

anaphylactoid who there rash in PR and cardiac interval had had

12-hour variable, and

In been

1 for gross had of

followed several of child because remained

child only hematunia. been a

(Case 9) 6 months, of followed the

white

cells

interpretation

been episode One clinic had

recurrences

counts

impossible. be seen fell in into Figures 2 distinct counts. had Sixurine normal 11, 14,
had urine 7,

In 8, and

general, 9, the

as can children

prolonged

in the electrocardiogram.
unchanged

The
for

PR

interval
and

groups in respect to their Addis teen of the children on follow-up

2 years

the patient of cardiac cardiographic a normal

experienced of childhood

had shown abnormality; finding variant.

the without

no other evidence thus, the electrowas considered children to be had

diseases

which can be considered within limits. Ten of the children (Cases 16, 17, 18, 19, 21, which, on the basis peated abnormal normality excessive Addis counts, 23, of 24, the must
25)

average be The excretion and

of

reabof in

Most
usual

of the
contagious difficulty.

considered

by current cniteria.114 involved the urinary numbers of red cells

On

physical

examination

the

height

and

casts;

200

\VEDGWOOD

ANAPHYLACTOID

PURPURA

12

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LU
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10
w

6
4

0 -J

I C)
U-

0 LU

U0

I
0 2468and YEARS over
0 I 2345678 RBC/ 12 hrs. XI00,000 and over

I0

z
LU -J I

8
6

C)
U-

0
LU

Fic. 6 (Upper period. FIG. 7 (Upper at follow-up:

per 12 hours.

left).

Length

of follow-up
found

right). Expressed

Hematunia

as

RBC

10

Fic. 8 (Lower left). follow.up: Expressed

Cylindruria as casts

found at 10 per

12

hours.

#{174}
only creased these
0

20406080 CASTS/

XI000
3 was to (Cases Six children proteinuria#{176} a significant 17, 23, 24) 16, degree, it was 17, consistently and not even a striking 26) had on pro. inin

finding. exception marked tant

hemolytic

On

repeated

Addis

counts,

with

the

of 1 child increase in with pharyngitis

streptococci,

(Case 17) hematuria caused

the nature

who had concomiby

and

(Cases

18, 2:3, 24,

beta
de-

increased follow-up. teinuria

proteinuria in 1 or more specimens however, in 3 (Cases 16, 18, 26) was not consistently abnormal.

gree ably

of the consistent.

abnormality

remained

remark-

ORIGINAL
P11OO1/lliNJtI

ARTICLES
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,

201
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202

WEDGWOOD

ANAPHYLACTOID
the disease this

PURPURA
began its acute group. that be this over phase This (X2 subsequent expected the age. can also be seen at chilSeven of nine age was difference 10.4, to be p urinary more of 6 years found is <

in 0.01)

abnormal and suggests

may

z
LU

statistically
abnormalities

significant

0 -J

frequent than This the dren during over 25 50 PROTEIN,

Fic. 9. Iroteinuria
as

in children in those age with the below differential of the

onset

disease.

hematunia, acute phase of 6 years. between and III). or Six

proteinuria, or both of the disease were There initial nine was on children also followwith a the of proteinuria

the age hematuria, (Table of the

and over MG / 12 hrs.

Expressed

relationship and up phase

its presence during found

found at follow-up: mg./12 hr.

hematuria

proteinuria disease were was

the acute to have uriHowever, Of 17 chilhad normal

The
dude

10 children
6 males and

with significantly entire

followed to

abnormal
a sex

urine
ratio

inof

4 females,

nary abnormality the relationship dren who were

on follow-up. not absolute. to have III

INITIAL FINDINGS AND

1.5: 1, a ratio the

of

not
been

different group.
for the an average normal

from 10
average of 4.8

reported TABLE

sex 4.3

ratio
have years, for the

of the
similar group

These

children years

RELATIONSHIP

OF URINARY

LATE

with

urine.

Seven
than
ease.

of the
3 years

ten
from

have
the

been
onset

followed
of the initial

more
disSubsequent Initia I Urinary Ilematuria 4 Findings Normal 4

The

abnormal

urinary

findings phase the

cannot of the 1 child in-

zndznys

be considered part of the acute disease in any of the children; with continued purpura (Case correlation eluded in this group. There was a distinct the age of disease and
normality per of cent) onset of over the

Prokinuria
6

Urine

9) is not between

abnormal
Urine
3

13

the child at the onset of the later finding of urinary II). While
the age disease had of 6 years

the abtime
urine

normal

(Table

9 of the 13 (69 at the 1 of when

abnormal

urines the found tion renal There tween initial quent was ously,9 tions on

(Table initial on disease. was to belong

III) phase subsequent also no

on routine of the

analysis disease, group with 4

during were latent beof the subseNor previexacerbaexamina-

follow-up in the apparent or the disease

follow-up (8 per cent)

examination, under the

FABLE

only age
II
AGE ON AT ONSET

13

of 6 years

relationship duration and the abnormality. reported between urinary who

RELATIONSHIP URINARY

BETWEEN FINI)INGS

AND

the severity phase of the

FoLLow-UP

(ri,zc
Age at Oruel Normal

on Folithe-up

finding of urinary there, as has been any of relationship and Of purpura

- - __________
Abnormal 1 9 11 4

abnormality had such found while were were unines,

follow-up.

10 children

tfl(ler6VarS Over
(X=10.5

6 ye:irs
p<O.Ol).

exacerbations, in the group the 6 other

4 subsequently with abnormal children in this

group

ORIGINAL
among

ARTICLES
ratio
gests

203

the

16

who

had studies

no

exacerbations. were performed

in children
that, while

with
there

abnormal
is a sex

urine
differentia-

sugmani-

More
on

complete

the

10 IV).
no

children In
striking or
Four

with general
of

abnormal these studies

urines rehad
cent

tion tiation
urinary

in the

attack there attack

rate is no

of the marked rate

purpunic sex

(Table
vealed
of renal

festations,

differen-

uniform

impairment

in the

of the

subsequent

function.

the
below

children
70 per

abnormality.

average

urea

clearances

of urine

normal fluid above

and

1 child

failed, gravity
were

during of 1.015. obtained

prohis Inon
there urinary

Renal purpura disease Osler,5 lieved tion. patients disease acute view throughout of

manifestations have been was first

of anaphylactoid recognized since

the

longed
tnavenous

deprivation, a specific
pyelograms children, and abnormality

to concentrate

described.

Henoch,3

and more recently this to be the most Pathologic during have the the shown widespread body, renal of the studies the acute early

Gairdner beserious complicakidneys phase changes Indeed, vascular it should lesions be exwould vascular urinary
in

8 of these
was no

in

each of

case the

of the

from of of the subin

visible

tracts.
TABLE FoLiow-uI IV
STUDIES

glomerulonephnitis.1

Case

Urea

highest

\umber 11 14 16 17 18 19 1 23 24
l5
*

Present .lge 10 8 H 14 1 13 14 13 15
of

Length
1ollol1-uJ)

of

(learance*

Urine Sp. Gr.j

pected that such be found. Because involvement, and

involvement the known nature of the

(%)
1.50 105 89 86 180 13 64 56 67 68 clearances

9/P1 6/12 9/12 5/1 4/1 8/1 5/12 7/1 2/12 4 to

7 2 6 6 4 S I 2 3

/1 6/12 t)/I2 6/1 2/1t 0/U 9/U 6/U 0/1

1.030 1.038 1.035 1.015 1.036 1.03 1.040 1.07 1.040 1.040 of 1 hour

abnormality, this sequel the 10 children in this best The formed

is

to the disease series seems to of latent nephnitis. contained fewer less protein
or

fit

into the classification urine, while abnormal, elements

seen in

and none of

than
subacute

usually

chronic

411/1

nephritis,

and

the

children

as

yet

13 10/1st

shows constitutional insufficiency. There is not enough the after the the of for within employed either the to evaluate dren, who, of the

manifestations data in the

of renal literature these period a most have the

of
15

Average

8 maximal

each.

.t Following

prognosis for a prolonged manifest It seems must following

attack the

clii!of latent likely

fluid

deprivation

of 1

to 30 hours.

follow-up, phase that

apparently disease. years

of

DISCUSSION
At follow-up considered
mality cylindruria
is

hematuria

existed initial a of
purpura.

least

10 study

of

the have

26 urine The
by

children that urinary

hematunia proteinunia.

in must

this be
and The

throughout
manifestations

abnormal.
characterized

abnor-

The grave this We phritis lesion lowing

majority outlook disease have may these to can purpura,

rt5 nephritic

describe sequelae

rather

than

length urine phase found

over

of follow-up precludes being considered part of the most the purpura, It is than age disease. often and during generally
occurs purpura

the of

abnormal the acute was were of onset or of that

commonly

only a year the term to heal any the so suggest or we

of its onset. latent nethat the In taken prognosis of renal anaphylacduraof of renal folcare in disdisthe

advisedly

The in who the

abnormality who time phase

more

progress. have

children at the had acute accepted The

children

of 6 years

to avoid order ability ease known toid

discussing minimize the produce pathologic the which

serious impression easily.

of
illness.

hematuria

proteinuria
phylactoid

the anasex

discussion findings probable

However, prolonged

in

males

females.19

similar

204 tion
clearances

WEDGWOOD of the to serious renal hematuria, found concentrate suggest for nature sequelae. is no known therapy of anaphylactoid hormone
used been

ANAPHYLACTOID urea in 1 of characterized lesion, can manifestations

PURPURA and exist in alone. recognized a form by with its skin

the 4, and urine

decreased the found at least not

in

decreased a potenuncomrenal Adto preabnormalievidence

visceral

ability these tially mon There sequelae

have

10 children,

these

SUMMARY
A long-term follow-up dren with anaphylactoid lein-Henoch average length study of purpura 26 chil(Sch#{246}n-

for the purpura. and appear

renocorticotropic vent ties;8 that Whether vented acute quate

also

cortisone

Syndrome) is presented. The of follow-up was 4% years. 10 were nephritis and proteinunia. over the of found characterto but

but there forms

do the is of be

not urinary

or
16

ameliorate and some the

Of these 26 children, have an apparent latent ized

7

suggestive renal disease can treatment bed for

the

by

hematuria

cylindunia, age

in

these be in prethe adeis

of

hormones

may renal

without marked ten children were the phase this pura chronic
ogy

Nine of the of 6 years at 6 had the proacute that purorigins etiolof

sequelae

time of renal may

of or the

onset hematuna disease.

purpura; during It is

by more rigorous phase (e.g., prolonged antibiotic

unknown.

teinunia

rest,

suggested

therapy
Because

infections)
majority

sequela constitute

of

anaphylactoid one of the

children who over the age attack,

tuna apy,

develop this complication of 6 years during the have

should to this

are acute hemathen-

renal disease which occurs in

of unknown adult patients.

and or
if use(l,

at that such

time

either
be

proteinunia,

preventive
As with all

ACKNOWLEDGMENT
The bers
drens study.

probably group.

directed chil-

authors of the Hospital house

are for

indebted staff their

to assistance

the and

memChilin this

particularly

of Babies

dren current
ously;

who
one

have infection
of

latent should
the

renal be
children

disease, treated
in this

intervigorseries

( Case
increase
ately

17) in

had

a pronounced during
a beta to

and and
hemolytic

sudden immedistrep-

REFERENCES
1. Gairdner, drome. 2. Henoch, D. : The Sch#{246}nlein-Henoch SynQuart. J. Med., 17:95, 1948. E. : Ueber eine eigenthumliche Form von Purpura. Berl. klin. Wchnschr., 11:641, 1874.
E. : Vorlesungen ilber Kinder-

hematunia

subsequent

tococcal
Many

infection.
adult patients with chronic ne-

phritis lonephnitis
suggest

give that

no and few, progress

history current if any,

of

acute

glomeruwith
glomeru-

pediatric children
acute

3.

Henoch,

the One who life

classic

post-streptococcal

lonephritis

to a chronic

phase.

wonders whether some of the patients have chronic renal disease in adult might lactoid been cant, haps have had a mild episode purpura#{176} in childhood thought at the time to

of anaphywhich had be insignifi-

or else had passed unnoticed. Perthis generalized disease, which is

krankheiten, 10th Ed. A. Berlin, Hirschwald, 1899, p. 839. 4. Sch#{246}nlein, J. L. : AlIg. u. spec. Path. u. Therap., Henisau, Lit.-Compt., 1 1:48, 3rd Ed., 1837. 5. Osler, W. : The visceral lesions of purpura and allied conditions. Brit. M. J., 1:517, 1914. 6. Sheldon, J. H. : Purpura Necrotica. Arch. Dis. Childhood, 22:7, 1947. 7. Levitt, L. M., and Burbank, B. : Glomerulonephnitis as a complication of the

o Eight of the ten children with abnormal urine left the usual pediatric age group prior to the finding of urinary abnormality at a time when they were thought by their families to be entirely well.

Sch#{246}nlein-Henoch Syndrome. New England J. Med., 248:530, 1953. 8. Wedgwood, R. J. P., and Janeway, C. A.: Serum complement in children with collagen diseases. PEDIATRICS, 11:569, 1953.

ORIGINAL
9.

ARTICLES
se supone de de las Los que est#{225} condicionada y que enfermedades presentan este y naturaleza del padecimiento, 26 por pertenece trabajo un

205
estado

10.

11.

12.

G. : The Sch#{246}nlein-Henoch childhood with particular reference to the occurence of nephritis. Arch. Dis. Childhood, 27:480, 1952. Ackroyd, J. F. : Allergic purpura, including purpura due to food, drugs, and infections. Am. J. Med., 14:605, 1953. Lyttle, J. D. : The Addis sediment count in normal children. J. Clin. Investigation, 12:87, 1933. Giles, Margaret D. : The Addis count in the prognosis of acute nephritis in childhood. Arch. Dis. Childhood, 22:232,
in

Philpott, Syndrome

NI.

hipersensibilidad llamadas autores

a! grupo para

col#{225}genas. de las secuelas segdn las 13 17

se#{241}alarIa presencia a Ia fase aguda observaciones meses a 12 ninos familiar piirpura padecimientos

sobre y medio nadie de

niflos estudiados, de aflos de edad, siendo de Ia raza estos ninos negra.

y 9 niflas, cercano anafilactoide

Ning#{241}n

present#{243} iii de los llamados

ni ninguno

col#{225}genos.

1947.
13. Addis, T. : Clomerular Nephritis: Diagnosis and Treatment, 1st Ed. New York, Macmillan, 1948. Ham, T. H., Editor: A Syllabus of Laboratory Examinations in Clinical Diagnosis, 1st Ed. Cambridge, Harvard, 1953. Ferrari, M., Lapido, C., and y Scherschemer, J. : Smndromes renales en el p#{241}rpura reumatoide. An. Fac. med. \Iontevicleo, 38:239, 1953. Philpott, NI. C., and Briggs, J. N. : Treatmeat of the Henoch-Sch#{246}nlein Syndrome with adrenocorticotropic hormone and cortisone. Arch. Dis. Childhood, 28:57, 1953. \Iichaels, L., and Walters, C. : Increased
hematunia in nephritis during cortisone

Trece
fecci#{243}nde

de

los veintis#{233}is ni#{241}os padecieron

las vIas
0

ina Ia 4

respiratorias

altas

inmediatamostraron

14.

mente antes iniciaci#{243}n de antecedentes padecIan aguda,

Ia

bien concomitantemente p#{241}rpura; 4 niflOs de alergia

familiares

otros Ia fase sIntomas

15.

alergia en si mismos. Durante 12 de los 26 imos presentaron (11 emesis; dolor 2 con

gastrointestinales episodios de

abdominal y melena abundante

16.

se operaron pens#{225}ndose sec#{225}ndole al primero una gangrenado en el Los presentan se se les complicaciones encuentran con definitiva que Ia fase no aguda puede de en acuerdo se divideron forma renal, de otro). datos en pero Algunos de las sin de laboratorio figuras el las

en invaginaci#{243}n reporci#{243}n de intestino el diagn#{243}stico niflos efecto. y 3, punto 4, 5 de de 7, 10 evoluci#{243}n

y

conflrmarse estos

recibieron se las De imos en lesion parte

antihistam#{237}nicos

sin mingn

17.

6. A todos
vista cuyos 8 los de como y 26 de 9. datos

and

adrenocorticotropic ministration. Arch.

Dis.

hormone Childhood,

ad28:

observ#{243} desde renales, en dos Ia cuento

resumen figuras de grupos; Addis

213, 1953.
18. M. I. : Disturbances of the kidney, Mitchell-Nelson Textbook of Pediatrics, 5th Ed., Waldo E. Nelson, Editor. Philadelphia, Saunders, 1950, p. 1217. Goettsch, Elvira: Nephnitis and nephrosis, ill Brennemanns Practice of Pediatrics, III. Hagerstown, Prior, 1948, chap. 28, p. 7. Rubin, in

presentaron

manifestaciones considerarse Ia enfermedad.

19.

Se observO

una
renal, pero ciaciOn

correlaciOn
caracterizada sin proteinuria

deflnida
por los

entre
si su

Ia edad
grado nueve de edad Ia fase

del

ni#{241}o

a! iniciarse

el padecimiento acentuada:

de lesiOn con

hematuria 6 aflos durante antes

y cilindruria

SPANISH

ABSTRACT

mi-

despu#{233}s de y hematuria

(6 con aguda edad; no de ni inicial renales

Piirpura Anafilactoide ( SIndrome de Schonlein-Henoch ) : Estudio con referencia especial a Complicaci#{243}n Renal
La
cas

proteinuria del padecimiento)

y sOlo uno

de esta

esta diferencia Tambi#{233}n se absoluta, iniciales revisiOn. de entre del de

y

es estadIsticamente encontrO relaciOn, Ia se proteinuria en las de relaciOn anormalidades entre Ia fase Ia revisiOn diferencia aguda de y persistencia encontrO y las ni tampoco durante en o duraciOn

significativa. aunque hematuria consultas aparente Ia fase

entre su No

p#{241}rpura anafilactoide caractenizada Ia piel, articulares se v Henoch que Se le por estos desconoce generalmente y asocian a de

es una por lesiones

enfermedad especifigastrocl#{225}sica del pero agregadas

generalizada sintomas intestinales; Schonlein

Ia intensidad padecimiento

menudo los nombres hicieron la etiologla

subsecuentes de Ia pOrpura dades tanto urinarias que se

Ia exacerbaciOn y anormalilos casos. En

Ia descripci#{243}n autores

y r

completa
adecimiento.

observO

del

sexo

en

206

WEDGWOOD
de
en

ANAPHYLACTOID 3 annos 4 annos. autores,

masculos.

PURPURA con un major concentration inter 2 e De accordo con reportos per altere circa duo tertios del patientes esseva
Ben que le contemporanee popula-

cuanto a Ia incidencia purpOricas, no la hubo complicaciOn El valorarse; sideran existe ciones pronOstico Ia grave tratamiento renales; las autores de una crOnicos Ia de para renal mayorIa las efectivo en caso de

las manifestaciones Ia incidencia de ni#{241}os no los para existir autores nefrIticas. las deben que de las complicatratarse secuelas pueden lo puede

la

subsecuente. estos de secuelas de conNo

en#{233}rgicamente Nuestros renales constituir renales los adultos.

infecciones consideran

intercurrentes.

tion total del hospital includeva 20 pro cento negros, nulle negro esseva trovate inter le 36 patientes de purpura anaphylactoide. Iste differentia es possibilemente debite al difficultate de discerner purpura super un pelle
negroide.

pOrpura las de

anafilactoide causas etiologIa desconocida

In
currentia en

le familias
de ni
Un

del
purpura

patientes
frequentia

nulle
inusual

altere de annos caso

oculle o le

padecimientos

anaphylactoide

esseva

constatate,

altere In

morbo collagenic. le majoritate del

habeva passate habeva Illo 2 casos
median

patientes
le prime

duo In un

INTERLINGUA
Purpura tinuation Anaphylactoide

ABSTRACT

plus

inter essite essite 15

declaration in un que un altere anno serie a

del

morbo

e le presente
habeva

studio.
annos, minus pro

Sch#{246}nlein-Henoch
a Longe

):

( Syndrome de Studio de ConDurantia con

intervallo 8 annos. in solo

Un longor

e amontava

le integre

Referentia
Involvimento
Le pro sequelas
phylactoide.

Special
Renal
esseva e de del in frequente con justificar representa pertine al acute

a
interprendite natura del ananon de extense es purpura morbo illo

Con
solmente

de 4 e 3 annos. le so! exception de un caso observate durante 6 menses, omne le patientes

studio habeva essite sin symptomas mdi-

studio determinar del lue

hic

presentate le phase frequentia

in iste

cative de purpura anaphylactoide. In 10 casos-6 masculos e 4 femininas-nostre constatationes indicava un latente nephnitis
charactenisate per hematuria e

Ben cognoscite, lesiones precedente, hemolytic purpura appellate

le le

etiologia occurrentia

cylmnduria

sed

vascular e de specialmente beta, pare anaphylactoide e morbos

infectiones streptococcos le these que un stato de del si-

hypersensibilitate

gruppo

sin pronunciate proteinuria. Iste gruppo includeva 9 patientes de plus que 6 annos de etate a! tempore del declaration del morbo. Jib includeva 6 casos de proteinuria o hematuria durante be phase acute del morbo. Il pare possibile que iste typo de sequela
renal de origines purpura de que anaphylactoide chronic occurre de purpura morbo in renal patientes constitue a etiologia adulte. un del

collagenic.

Le

protocollos
a

del
un

Hospital
Ohio, revela

pro
pro

Infantes
le annos

e
de il

J uveniles

Cleveland,

incognoscite

ab 1939 a 1953 casos de purpura

total de 36 anaphylactoide.

admissiones In 1954 patientes. de sanitate presente declarae 12

Le historia
episodio

de
juvenil

tab casos de

include

forsan

un leve conesseva iste

anaphylactoide

esseva possibile trovar 26 de iste Illes omnes se trovava in bon stato e in reporto. br totalitate del morbo forma patientes esseva le base del

que

a! tempore
como

su occurrentia

esseva

siderate recognoscite

mnsignificative o non del toto. Possibilemente

Le etate
tion del

a! tempore inter 13

del menses

morbo, que es characterisate e recognoscite per su besiones dermatic, pote exister in un forma con manifestationes exclusivemente visceral.