Age: 4.0
Sex: F
Vaccine: DTAPIPV, MMRV
Symptoms: Henoch-Schonlein purpura, Hypertension, Mobility decreased, Pain in extremity, Peripheral swelling
Clinical narrative: ?Henoch-Schonlein purpura (HSP) is a disease involving inflammation of small blood vessels. It most commonly occurs in children. The inflammation causes blood vessels in the skin, intestines, kidneys, and joints to start leaking. The main symptom is a rash with numerous small bruises, which have a raised appearance, over the legs or buttocks.  Although HSP can affect people at any age, most cases occur in children between the ages of 2 and 11. It is more common in boys than girls. Adults with HSP are more likely to have more severe disease compared to children.  HSP usually ends after four to six weeks -- sometimes with recurrence of symptoms over this period, but with no long-term consequences (recurrences are fairly common). If organs such as the kidneys and intestines are affected, treatment is often needed and it is important to have regular follow-up to prevent serious complications.  The exact cause of HSP is not known. The body's immune system is believed to play a role in targeting the blood vessels involved. An abnormal immune response to an infection may be a factor in many cases. Approximately two-thirds of the cases of HSP occur days after symptoms of an upper respiratory tract infection develop.  Some cases of HSP have been linked to vaccinations for typhoid, cholera, yellow fever, measles, or hepatitis B; foods, drugs, chemicals, and insect bites. Some experts also say that HSP is associated with the colder weather of fall and winter.  HSP can cause kidney problems, indicated by such signs as protein or blood in the urine. This is usually only discovered on urine testing, since it does not generally cause any discomfort.  In most patients, the kidney impairment is mild and goes away without any long-term damage. It's important to monitor the kidney problems closely and make sure they clear up, since about 5% of patients may develop progressive kidney disease. About 1% may go on to develop total kidney failure.?  Patient, 4 years old, had to have her vaccines to start Pre-K , so on 8/06/19 she got her vaccinations. Then last Saturday, 8/24/19, she developed a bad cough. She wasn?t better by Monday so we did not send her to school and she went to her doctor that Tuesday, 8/27/19. She was then treated for an upper respiratory infection and had a follow up appointment that Thursday, 8/29/19. We got a call from the school saying she couldn?t bare any weight on her legs and that she had really bad bruising on her legs. She was fine when she got on the bus. Long story short...we get to the ER and after a CT, X-ray, and CBC she was diagnosed with HSP.   From Thursday to Friday her blood pressure was very high and she had blood in her urine. She had bruising from her buttocks to her toes and her palms were bruised. Doctors were in and out like crazy checking blood pressure and examining her joints and the new bruises that were appearing on her legs and feet and even on her hands. She complained that her stomach hurt, her head hurt, her legs hurt, and everyone seemed to be at a loss.  Around 4pm on Friday she still could not walk or move her legs at all and the swelling and bruising had not dissipated. She would scream because the pain in her legs was unbearable. She wanted to take a bath around 4:30 and we thought it would help her joints to sit in a hot bath. She could only bare weight for maybe 5 seconds without crying and saying it hurt. About an hour later she started moving her feet and toes, then bending her knees, and then moving her legs.  Then about 30 minutes later she needed to pee and actually walked back to the bed from the bathroom. Then started bossing people around and wanted to stand and sing us a song. My typical bossy patient! She went to the foot of the bed and started sing. We all started to cry. Prayer works in case you didn?t know.  Saturday morning we thought her IV went bad because her left arm started showing signs of swelling but no bruises. Then we literally sat there and watched her arms start to have bruising appear as she slept. Her swelling was so bad they had to remove her hospital band because it was digging into her skin. Her legs that morning were not as swollen and she seemed to not be in as much pain. The doctors were still worried about her kidney functions and her high blood pressure. We still are not out of the woodwork yet with that.   Thankfully today at 3 yesterday (Sunday) we were able to go home. We still have many months of follow ups to do to check her blood pressure and to do urinalysis to check for protein and blood in her urine and we still have to monitor her input and output. Prayers are still greatly needed and appreciated.  This is a very rare thing that can happen to your little one and I was scared out of my mind with what could be causing this type of reaction. It affected her skin, intestines, kidneys, joints, and now we have at least 4 months of weekly checkups until she is in the clear. Hopefully sooner.   Please SHARE this to let people know that this could happen if your child has had shots (MMR) and then recently received medical attention for an upper respiratory problem. It was the perfect storm for her to get it. There is not much known about the why or how exactly a child contracts this but it can have lifelong affects. Prayers it does not with patient. This was not her first time getting treated for an upper respiratory problem or getting vaccines. But for whatever reason now she has HSP which had this response that is known to be linked to the MMR vaccine.   She had no signs of it when she got on the bus and it didn?t take long to progress and just as quickly it dissipated.  Thanks for taking the time to read this and share. Maybe it will get around to enough people that it will get some awareness and help another child get medical attention sooner.