Case History

On February 2, an upstate pediatrician consulted with Dr. Schuman regarding a four year old who was hospitalized in intensive care since the previous afternoon. The child’s symptoms upon arrival at the emergency room included lowgrade fever, nausea, and vomiting. Approximately three hours later the child vomited blood, developed a purpuric rash, and was dehydrated.

The child was suspected of ingesting a ‘yellow, gritty, sandy substance’ from a can she took from the pesticide storage area of a barn. On the day of admission to the hospital, she was found by her parents playing with the contents of the can. The can was old and was without a label.

Both Dr. Schuman and the pediatrician agreed that the possible ingestion of the unidentified chemical was a “red herring” and did not explain the child’s illness.

Laboratory tests and clinical symptoms were consistent with Henoch-Sch`nlein allergic purpura. The disease is defined as an acute or chronic vasculitis affecting primarily small vessels of the skin, joints, GI tract and kidney. The disease occurs primarily in small children. It is triggered by either an acute respiratory infection or by a drug (especially sulfas). The parents confirmed that their daughter had a respiratory infection 10 days prior to hospitalization.

DEPARTMENT OF FAMILY MEDICINE – DIVISION OF PUBLIC HEALTH AND PUBLIC SERVICE

MEDICAL UNIVERSITY OF SOUTH CAROLINA, 171 ASHLEY AVENUE, CHARLESTON, SC 29425-2217