In more severe cases, hemorrhagic, purpuric or necrotic lesions may be prominent. It is mandatory to differentiate these lesions from those of meningococcal septicemia or other septic emboli or toxic vasculitides, such as those seen with drug reactions, iodides and arsenicals. The most common complaint is colicky abdominal pain, which may be severe and associated with vomiting. The pain may mimic that of an acute abdomen. Severe cases may proceed to intussusception, hemorrhage and shock.
Younger children are less likely to exhibit gastrointestinal symptoms.
11 Endoscopic evaluation often shows mucosal erosions and swelling. The third symptom of the triad is arthritis characterized by warmth, tenderness and swelling of the joints, particularly the large joints. Joint symptoms occur in 70 percent of cases, are transient and leave no permanent deformity. 12 Joint symptoms may precede the rash in 25 percent of cases. 3 Figure 1.