A Case of Henoch-Schonlein Purpura (H-S P)

(Reprinted from Similia courtesy Gwyneth Evans)

(Henoch-Schonlein Purpura refers to an acute or chronic vasculitis affecting primarily small vessels of the skin, joints, G.I. tract or kidney.)

The disease primarily affects young children but may affect older children and adults. An acute respiratory infection precedes purpura in a high proportion of affected young children. Less commonly, a drug may be the inciting agent, and a drug history should always be obtained. – Merck Manual Seventeenth Edition

Female, 3.5 years

On 27 Feb evening her face had started to swell. One week before that she had complained of a sore tummy. She was first seen in hospital on 28 Feb.  Anna (not her real name) presented with a diagnosis of H-S P when I visited her in hospital. She had been admitted because of the pain, swelling and ‘bruising’ of her lower limbs. The swelling was from the knees down, in particular both feet.

Pain in the joints, < touch. Stiffness < after sleep. Refusing to walk or to stand because of the pain and swelling, plus what appeared to be a weakness of the legs. Anna just wanted to be held by mother and if put down as if to stand, her legs simply folded. Difficult to judge if it was weakness or pain.

The purpura appeared as purplish-blue spots or patches which looked somewhat like bruises, mostly on her legs though she did develop some on her buttocks as well. The discoloured patches varied in size from 1.5 to 3 cm diameter, irregular shapes.

In general, Anna is an outgoing, sociable child, who easily talks to adults. She has an ability to chat with her grandparents who died a few years before she was born.

The remedy quickly given was Phosphorus as it fitted both the rubric ‘EXTREMITIES, Discoloration, Lower Limbs, purpura haemorrhagica’ and the type of child, including the clairvoyance.

This remedy helped Anna to feel better in herself; “It keeps her calmer,” her mother said. “It made a big difference.” She was more settled, less restless. Back to normal with eating. The swelling was less.

However there remained a stiffness on waking, and needing conventional pain relief quite frequently. Without it she would stiffen up again. She was still getting more spots on her abdomen. Large patches 5cm across on her buttocks. And some “lumps that look a bit like insect bites but they aren’t doing what a bite would normally do on Anna.” Usually she would have a strong reaction to insect bites with a lot of itching and scratching.

Her eye was swollen. Swelling on the bridge of her nose and forehead.

She was complaining of a sore tummy.

The information given to the parents when at the hospital was that the cause was unknown. At this point I inquired more deeply into any possible causation/s and her parents had been thinking about this too, wondering if the illness had anything to do with some weedkiller they had sprayed, or some insect repellent sprayed on her skin. 8 months ago, Anna had had what appeared to be a scratch on her hand that grew to 2.5 cm diameter. Six months ago she had an infected blister on her heel that swelled up and took a time to improve.

Pondering all of this, I slept on it, waking the next morning thinking Ledum. She needs Ledum. Sometimes the simplest answers elude us for a time.

Ledum (quoting from Morrison Desktop Guide):

Purple discoloration and swelling. Ecchymosis and bruising. Purpura.  Aetiology of insect bites, puncture wounds. Rheumatism, mainly of lower extremities. Rheumatism with pain and stiffness. Rheumatism ascends during the course of an illness to more proximal joints.

Rx: Ledum 200c given on March 10

Report from mother 3 weeks later:

“Anna is doing fantastic. There was an almost instant change after the remedy. Overnight she became more alert, the bruising slowed down and she was able to function so much better.”

“Pretty much from then on has not needed pain relief.”

“Now at about 6 weeks since it started she has not had any new bruising for 3 weeks (since remedy). There are still some faint marks where the bruises were on her thighs.”

“I don’t think it would have cleared so quickly without your help.”