Small Vessel Vasculitis

Henoch-Schonlein purpura (HSP) is the most common juvenile form of small vessel vasculitis. Although HSP is seen in adolescents, the peak age-of-onset is 4-6 years (18). There is an association with preceding infection in up to half of cases (38). HSP presents with the combination of non-thrombocytopenic palpable purpura over the lower extremities, abdominal pain, arthritis, and glomerulonephritis. Pathologically there is IgA deposition in the glomerular mesangium or the dermal vessels (39). HSP is a self-limiting disorder that carries an excellent prognosis. Although 20% to 50% of cases may be associated with renal involvement only 1% progress to chronic renal insufficiency (40). However, it should be noted that this risk is greater in adolescents (41).

Other forms of small vessel vasculitis seen in adolescents include hypersensitivity vasculitis (usually following drugs such as penicillin, antithyroid agents, retinoids) that is treated by removing the offending agent, and cryoglobulinaemic vasculitis that is rarely seen in the context of hepatitis C and intravenous drug abuse.

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