Atypical purpura location in a pediatric patient with Henoch-Schonlein purpura A case report

Rationale: The presence of purpura is a compulsory criteria for the diagnosis of Henoch-Schonlein purpura (HSP). Typical purpura of HSP is distributed symmetrically over the extensor surfaces of the lower limbs, buttocks, and forearms with the occasional involvement of trunk and face in children. It occurs only involving the bottom of the feet has never been reported. Patient concerns: A 7-year-old girl was admitted to the hospital with abdominal pain, vomiting, and fever. Diagnoses: Combining clinical manifestations with results of radiologic examinations, acute appendicitis was suspected and a laparotomy was considered. Purpura was found on the bottom of her feet when she was in the operating room and HSP was diagnosed. Interventions: The patient was treated with glucocorticosteroids, antibiotics, cimetidine, and restriction of feeding. Outcomes: The abdominal pain and purpura resolved at discharge and there were no recurrences in the subsequent 3-, 6-, and 12-month follow-ups. Lessons: Careful examination of skin including the bottom of the feet can help to direct the diagnostic workup for children with abdominal pain.